Organization
MIRACLE MILE POST ACUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL SOLORZANO (MANAGER)
(626) 346-0300
Entity
Organization
Contact information
Practice address
1020 S FAIRFAX AVE, LOS ANGELES, CA 90019-4401
(323) 938-2451
Mailing address
107 W LEMON AVE, MONROVIA, CA 91016-2809
(626) 346-0300
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555139
MEDICARE PTAN
CA
Enumeration date
07/11/2019
Last updated
07/11/2019
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