Organization
WILSHIRE HEALTHCARE CENTER LLC
Active
Other names
Country Villa Wilshire Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN REISSMAN (CEO/CHAIRMAN)
(310) 574-3733
Entity
Organization
Contact information
Practice address
855 N FAIRFAX AVE, LOS ANGELES, CA 90046-7207
(323) 596-2145
(323) 596-4645
Mailing address
5120 W GOLDLEAF CIR STE 400, LOS ANGELES, CA 90056-1297
(323) 596-2145
(323) 596-4645
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
910000149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05710J
—
CA
Enumeration date
03/13/2012
Last updated
02/07/2013
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