Organization
COUNTRY VILLA PARK MARINO HEALTHCARE CENTER, LLC
Active
Other names
Country Villa Park Marino Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E. REISSMAN (PRESIDENT OF CVHS, MANAGER)
(310) 574-3733
Entity
Organization
Contact information
Practice address
2585 E WASHINGTON BLVD, PASADENA, CA 91107-1446
(626) 463-4105
(626) 798-5121
Mailing address
5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
(310) 574-3733
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000088
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC05548F
—
CA
Enumeration date
09/13/2005
Last updated
01/20/2009
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