# 1100 SOUTH ALVARADO STREET, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Olympia Convalescent Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114291523
- **Authorized official:** MR. MARTIN WEISS (MANAGER)
- **Authorized official phone:** (818) 385-3200

## Contact information

- **Practice address:** 1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
- **Practice address phone:** (213) 487-3000
- **Practice address fax:** (213) 487-1909
- **Mailing address:** 1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
- **Mailing address phone:** (213) 487-3000
- **Mailing address fax:** (213) 487-1909

## Taxonomy

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

## Other

- **Enumeration date:** 03/02/2012
- **Last updated:** 07/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 05-6321 | MEDICARE ID - TYPE UNSPECIFIED | CA |
| 05 | — | 1114291523 | — | CA |
| 05 | — | ZZT18570G | — | CA |