# 5648 EAST GOTHAM STREET LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BRIARCREST NURSING CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548255284
- **Authorized official:** CAROLINE L BOYER (DIRECTOR OF PATIENT ACCOUNTING)
- **Authorized official phone:** (818) 367-9546

## Contact information

- **Practice address:** 5648 GOTHAM ST, BELL GARDENS, CA 90201-5413
- **Practice address phone:** (562) 927-2641
- **Practice address fax:** (562) 927-4639
- **Mailing address:** 5648 GOTHAM ST, BELL GARDENS, CA 90201-5413
- **Mailing address phone:** (562) 927-2641
- **Mailing address fax:** (562) 927-4639

## Taxonomy

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

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC70168F | — | CA |
| 05 | — | ZZT06220H | — | CA |