Organization
COUNTRY VILLA EAST L.P.
Active
Other names
Country Villa East Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E. REISSMAN (MANAGING MEMBER OF GENERAL PARTNER)
(310) 574-3733
Entity
Organization
Contact information
Practice address
2415 S WESTERN AVE, LOS ANGELES, CA 90018-2608
(323) 734-1101
(323) 734-3872
Mailing address
3580 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90010-2502
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT06114H
—
CA
Enumeration date
09/01/2005
Last updated
09/14/2022
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