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Organization
1100 SOUTH ALVARADO STREET, LLC
Active
Organization
1100 SOUTH ALVARADO STREET, LLC
Active
Other names
Olympia Convalescent Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN WEISS (MANAGER)
(818) 385-3200
Entity
Organization
Contact information
Practice address
1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
(213) 487-3000
(213) 487-1909
Mailing address
1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
(213) 487-3000
(213) 487-1909
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-6321
MEDICARE ID - TYPE UNSPECIFIED
CA
05
—
1114291523
—
CA
05
—
ZZT18570G
—
CA
Enumeration date
03/02/2012
Last updated
07/20/2014
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