NPIMap

Organization Active NPI

Japanese Home for the Aged

  • Nursing Facility/Intermediate Care Facility
  • Los Angeles, CA
National Provider Identifier
1063512978
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
970000039 Issued in CA
Legal business name
JAPANESE HOME FOR THE AGED
Doing business as
Keiro Intermediate Care Facility
Practice address
325 S Boyle Ave
Los Angeles, CA 90033-3812
Phone
(323) 263-9655
Fax
(323) 263-2721
NPI assigned
Sep 22, 2006
Organization subpart
Yes
Parent organization
KEIRO SENIOR HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Shawn Miyake
Title
President and Ceo
Phone
(323) 980-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 970000039 CA Primary

Addresses

Primary practice location

325 S Boyle Ave
Los Angeles, CA 90033-3812

Mailing address

325 S Boyle Ave
Los Angeles, CA 90033-3812
Phone (323) 263-9655

Other identifiers 1

IdentifierTypeStateIssuer
LTC90079FMedicaidCA

Other names 1

  • Keiro Intermediate Care Facility Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Japanese Home for the Aged2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1063512978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 S BOYLE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900333812",
            "telephone_number": "323-263-9655",
            "fax_number": "323-263-2721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 S BOYLE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900333812",
            "telephone_number": "323-263-9655",
            "fax_number": "323-263-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAPANESE HOME FOR THE AGED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEIRO SENIOR HEALTHCARE",
        "enumeration_date": "2006-09-22",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "MIYAKE",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "323-980-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "970000039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC90079F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keiro Intermediate Care Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.