# MID-WILSHIRE HEALTH CARE CENTER

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

## Provider details

- **NPI number:** 1528131612
- **Authorized official:** MS. JEOUNG HIE LEE (PRESIDENT)
- **Authorized official phone:** (323) 934-5660

## Contact information

- **Practice address:** 676 S BONNIE BRAE ST, LOS ANGELES, CA 90057-3710
- **Practice address phone:** (213) 483-9921
- **Practice address fax:** (213) 483-3606
- **Mailing address:** 1101 CRENSHAW BLVD, LOS ANGELES, CA 90019-3112
- **Mailing address phone:** (323) 934-5660
- **Mailing address fax:** (323) 934-0852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000071 | CA | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 10/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06174J | — | CA |