# LAKEWOOD MANOR NORTH INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083759500
- **Authorized official:** MR. KIM CHARLES ELLIOTT (ADMINISTRATOR)
- **Authorized official phone:** (213) 380-9175

## Contact information

- **Practice address:** 831 S LAKE ST, LOS ANGELES, CA 90057-4013
- **Practice address phone:** (213) 380-9175
- **Practice address fax:** (213) 380-1879
- **Mailing address:** 831 S LAKE STREET, LOS ANGELES, USA USA
- **Mailing address phone:** (213) 380-9175
- **Mailing address fax:** (213) 380-1879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000069 | CA | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 06/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06078F | — | CA |