Organization
KNOLLS WEST POST ACUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JOHNSON (CEO)
(310) 266-1080
Entity
Organization
Contact information
Practice address
16890 GREEN TREE BLVD, VICTORVILLE, CA 92395-5618
(310) 266-1080
(714) 256-2003
Mailing address
530 N PUENTE ST, BREA, CA 92821-2804
(310) 266-1080
(714) 256-2003
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55251F
—
CA
Enumeration date
10/11/2013
Last updated
12/30/2016
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