Organization
COUNTRY VILLA EAST, LP
Active
Other names
Country Villa Terrace Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL PETTERSON (VICE PRESIDENT - CAMS)
(310) 574-3733
Entity
Organization
Contact information
Practice address
6050 W PICO BLVD, LOS ANGELES, CA 90035-2647
(323) 653-5565
(323) 782-9516
Mailing address
3580 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90010-2502
(323) 330-6500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801126305
—
CA
Enumeration date
01/05/2010
Last updated
09/14/2022
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