Country Villa Imperial LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000041 Issued in CA

Legal business name

COUNTRY VILLA IMPERIAL LLC

Practice address

3002 Rowena Ave
Los Angeles, CA 90039-2005

Phone

(323) 666-1544

Fax

(323) 666-9584

NPI assigned

Sep 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Stephen E. Reissman

Title

Trustee of Managing Member

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Los Feliz Healthcare Center Doing business as

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390953600000",
    "number": "1083608293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561292",
            "telephone_number": "310-574-3733",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3002 ROWENA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392005",
            "telephone_number": "323-666-1544",
            "fax_number": "323-666-9584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA IMPERIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2014-01-29",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "TRUSTEE OF MANAGING MEMBER",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18588J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Los Feliz Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan Coulter, M.A., PCCI
• Country Villa East L.P.
• Country Villa East L.P.
• Country Villa East, L.P.
• Country Villa East, LP
• Country Villa Nursing Center, Inc.
• Country Villa Service Corp.
• Country Villa Westwood, a Ca LTD
• Kene Counts
• County of Los Angeles

• All providers in Los Angeles, CA
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; 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.