# COUNTRY VILLA EAST L.P.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Villa East Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043204324
- **Authorized official:** MR. STEPHEN E. REISSMAN (MANAGING MEMBER OF GENERAL PARTNER)
- **Authorized official phone:** (310) 574-3733

## Contact information

- **Practice address:** 2415 S WESTERN AVE, LOS ANGELES, CA 90018-2608
- **Practice address phone:** (323) 734-1101
- **Practice address fax:** (323) 734-3872
- **Mailing address:** 3580 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90010-2502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000018 | CA | Yes |

## Other

- **Enumeration date:** 09/01/2005
- **Last updated:** 09/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06114H | — | CA |