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Organization
COUNTRY VILLA EAST, LP
Active
Organization
COUNTRY VILLA EAST, LP
Active
Other names
Country Villa Terrace Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL PETTERSON (VICE PRESIDENT - CAMS)
(310) 574-3733
Entity
Organization
Contact information
Practice address
6050 W PICO BLVD, LOS ANGELES, CA 90035-2647
(323) 653-5565
(323) 782-9516
Mailing address
3580 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90010-2502
(323) 330-6500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801126305
—
CA
Enumeration date
01/05/2010
Last updated
09/14/2022
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