# COUNTRY VILLA SOUTH BAY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Villa Bay Vista Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447244801
- **Authorized official:** MR. STEPHEN E. REISSMAN (TRUSTEE OF MANAGING MEMBER)
- **Authorized official phone:** (310) 574-3733

## Contact information

- **Practice address:** 5901 DOWNEY AVE, LONG BEACH, CA 90805-4518
- **Practice address phone:** (562) 634-4693
- **Practice address fax:** (562) 630-2039
- **Mailing address:** 5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
- **Mailing address phone:** (310) 574-3733
- **Mailing address fax:** (310) 574-1322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 940000011 | CA | Yes |

## Other

- **Enumeration date:** 08/31/2005
- **Last updated:** 01/29/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06042J | — | CA |