# COUNTRY VILLA WESTWOOD, A CA LTD

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

## Provider details

- **NPI number:** 1750375705
- **Authorized official:** MR. STEPHEN E. REISSMAN (MANAGING MEMBER OF GENERAL PARTNER)
- **Authorized official phone:** (310) 574-3733

## Contact information

- **Practice address:** 12121 SANTA MONICA BLVD, LOS ANGELES, CA 90025-2515
- **Practice address phone:** (310) 826-0821
- **Practice address fax:** (310) 207-9311
- **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 | 910000123 | CA | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 03/31/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05060H | — | CA |