# KEIRO NURSING HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487754297
- **Authorized official:** MR. SHAWN MIYAKE (PRESIDENT AND CEO)
- **Authorized official phone:** (323) 980-7500

## Contact information

- **Practice address:** 2221 LINCOLN PARK AVE, LOS ANGELES, CA 90031
- **Practice address phone:** (323) 276-5700
- **Practice address fax:** (323) 276-5732
- **Mailing address:** 2221 LINCOLN PARK AVE, LOS ANGELES, CA 90031
- **Mailing address phone:** (323) 276-5700
- **Mailing address fax:** (323) 276-5732

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000059 | CA | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 07/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC55438F | — | CA |