Organization
MEK KENNEDY, LLC
Active
Other names
Kennedy Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FERNAN PEDRAJA (MEMBER)
(181) 824-7620
Entity
Organization
Contact information
Practice address
619 N FAIRFAX AVE, LOS ANGELES, CA 90036-1714
(132) 365-1004
(132) 365-1375
Mailing address
1506 S GLENDALE AVE, GLENDALE, CA 91205-3316
(181) 824-7620
(181) 824-7712
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0556903
CLIA ID NUMBER
CA
05
—
ZZT05977G
—
CA
Enumeration date
06/27/2005
Last updated
04/11/2016
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