Organization
MARYCREST MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA MALDONADO (ADMINISTRATOR)
(310) 838-2778
Entity
Organization
Contact information
Practice address
10664 SAINT JAMES DRIVE, CULVER CITY, CA 90230
(310) 838-2778
(310) 838-9647
Mailing address
10664 SAINT JAMES DRIVE, CULVER CITY, CA 90230
(310) 838-2778
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
910000079
CA
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05196F
—
CA
Enumeration date
09/06/2005
Last updated
12/18/2012
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