East Healthcare Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000018 Issued in CA

Legal business name

EAST HEALTHCARE CENTER, LLC

Doing business as

Country Villa East Nursing Center

Practice address

2415 S Western Ave
Los Angeles, CA 90018-2608

Phone

(323) 734-1101

Fax

(323) 734-3872

NPI assigned

Dec 11, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Cheryl A Petterson

Title

VP Business Services

Phone

(323) 596-2145

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa East Nursing Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1083959423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900182608",
            "telephone_number": "323-734-1101",
            "fax_number": "323-734-3872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900182608",
            "telephone_number": "323-734-1101",
            "fax_number": "323-734-3872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST HEALTHCARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "PETTERSON",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP BUSINESS SERVICES",
        "authorized_official_telephone_number": "323-596-2145",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06114H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa East Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.