# MARYCREST MANOR

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

## Provider details

- **NPI number:** 1932193984
- **Authorized official:** VERONICA MALDONADO (ADMINISTRATOR)
- **Authorized official phone:** (310) 838-2778

## Contact information

- **Practice address:** 10664 SAINT JAMES DRIVE, CULVER CITY, CA 90230
- **Practice address phone:** (310) 838-2778
- **Practice address fax:** (310) 838-9647
- **Mailing address:** 10664 SAINT JAMES DRIVE, CULVER CITY, CA 90230
- **Mailing address phone:** (310) 838-2778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 910000079 | CA | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | — | — | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | — | — |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05196F | — | CA |