Organization
LAKEWOOD MANOR NORTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIM CHARLES ELLIOTT (ADMINISTRATOR)
(213) 380-9175
Entity
Organization
Contact information
Practice address
831 S LAKE ST, LOS ANGELES, CA 90057-4013
(213) 380-9175
(213) 380-1879
Mailing address
831 S LAKE STREET, LOS ANGELES, USA USA
(213) 380-9175
(213) 380-1879
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000069
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT06078F
—
CA
Enumeration date
02/21/2007
Last updated
06/18/2012
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