# ICC CONVALESCENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IMPERIAL CARE CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265502405
- **Authorized official:** IRA DAVID FRIEDMAN (MANAGER)
- **Authorized official phone:** (213) 389-6900

## Contact information

- **Practice address:** 11441 VENTURA BLVD, STUDIO CITY, CA 91604-3143
- **Practice address phone:** (818) 980-8200
- **Practice address fax:** (818) 980-2234
- **Mailing address:** 4032 WILSHIRE BLVD FL 6, LOS ANGELES, CA 90010-3425
- **Mailing address phone:** (213) 389-6900
- **Mailing address fax:** (818) 762-8339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 920000042 | CA | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 09/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05418G | — | CA |