# GREEN ACRES LODGE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Green Acres Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669552022
- **Authorized official:** IRA DAVID FRIEDMAN (MANAGER)
- **Authorized official phone:** (213) 389-6900

## Contact information

- **Practice address:** 8101 HILL DR, ROSEMEAD, CA 91770-4128
- **Practice address phone:** (626) 280-2293
- **Practice address fax:** (626) 280-5685
- **Mailing address:** 4032 WILSHIRE BLVD FL 6, LOS ANGELES, CA 90010-3425
- **Mailing address phone:** (213) 389-6900
- **Mailing address fax:** (626) 280-5685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 950000052 | CA | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 09/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT18146K | — | CA |