MEDICARE: GOLDSTAR HEALTHCARE CENTER OF INGLEWOOD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	910000024	CA

General Provider Information

NPI Number	:	1972721355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDSTAR HEALTHCARE CENTER OF INGLEWOOD, LLC

Provider Business Mailing Address
First Line	:	515 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-3215
Country	:	US
Telephone Number	:	310-674-4500
Fax Number	:	310-674-9393

Provider Business Practice Location Address
First Line	:	515 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-3215
Country	:	US
Telephone Number	:	310-674-4500
Fax Number	:	310-674-9393

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DOV GOLDNER
Credential	:
Telephone Number	:	310-674-4500

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	06/15/2009

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