Organization
1100 SOUTH ALVARADO STREET, LLC
Active
Other names
Olympia Convalescent Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN WEISS (MANAGER)
(818) 385-3200
Entity
Organization
Contact information
Practice address
1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
(213) 487-3000
(213) 487-1909
Mailing address
1100 S ALVARADO ST, LOS ANGELES, CA 90006-4110
(213) 487-3000
(213) 487-1909
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-6321
MEDICARE ID - TYPE UNSPECIFIED
CA
05
—
1114291523
—
CA
05
—
ZZT18570G
—
CA
Enumeration date
03/02/2012
Last updated
07/20/2014
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