Organization
INTERCOMMUNITY CARE CENTERS, INC.
Active
Other names
Intercommunity Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL BOYDSTON (ADMINISTRATOR)
(562) 427-8915
Entity
Organization
Contact information
Practice address
2626 GRAND AVE, LONG BEACH, CA 90815-1707
(562) 427-8915
(562) 427-2348
Mailing address
2626 GRAND AVE, LONG BEACH, CA 90815-1707
(562) 427-8915
(562) 427-2348
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT18608H
—
CA
Enumeration date
01/19/2007
Last updated
08/22/2020
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