Organization
COUNTRY VILLA SOUTH BAY, LLC
Active
Other names
Country Villa Woodman Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E. REISSMAN (TRUSTEE OF MANAGING MEMBER)
(310) 574-3733
Entity
Organization
Contact information
Practice address
13524 SHERMAN WAY, VAN NUYS, CA 91405-2830
(818) 786-3470
(818) 786-0943
Mailing address
5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
(310) 574-3733
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05712J
—
CA
Enumeration date
09/06/2005
Last updated
08/22/2020
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