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Organization
WILSHIRE HEALTHCARE CENTER LLC
Active
Organization
WILSHIRE HEALTHCARE CENTER LLC
Active
Other names
Country Villa Wilshire Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN REISSMAN (CEO/CHAIRMAN)
(310) 574-3733
Entity
Organization
Contact information
Practice address
855 N FAIRFAX AVE, LOS ANGELES, CA 90046-7207
(323) 596-2145
(323) 596-4645
Mailing address
5120 W GOLDLEAF CIR STE 400, LOS ANGELES, CA 90056-1297
(323) 596-2145
(323) 596-4645
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
910000149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05710J
—
CA
Enumeration date
03/13/2012
Last updated
02/07/2013
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