Organization
KEIRO NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN MIYAKE (PRESIDENT AND CEO)
(323) 980-7500
Entity
Organization
Contact information
Practice address
2221 LINCOLN PARK AVE, LOS ANGELES, CA 90031
(323) 276-5700
(323) 276-5732
Mailing address
2221 LINCOLN PARK AVE, LOS ANGELES, CA 90031
(323) 276-5700
(323) 276-5732
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000059
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55438F
—
CA
Enumeration date
09/22/2006
Last updated
07/11/2013
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