# COUNTRY VILLA IMPERIAL LLC

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

## Provider details

- **NPI number:** 1083608293
- **Authorized official:** MR. STEPHEN E. REISSMAN (TRUSTEE OF MANAGING MEMBER)
- **Authorized official phone:** (310) 574-3733

## Contact information

- **Practice address:** 3002 ROWENA AVE, LOS ANGELES, CA 90039-2005
- **Practice address phone:** (323) 666-1544
- **Practice address fax:** (323) 666-9584
- **Mailing address:** 5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
- **Mailing address phone:** (310) 574-3733
- **Mailing address fax:** (310) 574-1322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000041 | CA | Yes |

## Other

- **Enumeration date:** 09/01/2005
- **Last updated:** 01/29/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT18588J | — | CA |