Lakewood Manor North Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000069 Issued in CA

Legal business name

LAKEWOOD MANOR NORTH INC

Practice address

831 S Lake St
Los Angeles, CA 90057-4013

Phone

(213) 380-9175

Fax

(213) 380-1879

NPI assigned

Feb 21, 2007

Last updated

Jun 18, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kim Charles Elliott

Title

Administrator

Phone

(213) 380-9175

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1083759500",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "831 S LAKE STREET",
            "city": "LOS ANGELES",
            "state": "USA",
            "postal_code": "USA",
            "telephone_number": "213-380-9175",
            "fax_number": "213-380-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 S LAKE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574013",
            "telephone_number": "213-380-9175",
            "fax_number": "213-380-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD MANOR NORTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "213-380-9175",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06078F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.