Organization
COUNTRY VILLA NURSING CENTER, INC.
Active
Other names
Country Villa Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E. REISSMAN (PRESIDENT)
(310) 574-3733
Entity
Organization
Contact information
Practice address
340 S ALVARADO ST, LOS ANGELES, CA 90057-2915
(213) 484-9730
(213) 484-9507
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
970000068
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC90020G
—
CA
Enumeration date
09/02/2005
Last updated
05/02/2022
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