SRSW LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SRSW LLC

Doing business as

Beacon Healthcare Center

Practice address

919 N Sunset Ave
West Covina, CA 91790-1244

Phone

(949) 445-1000

NPI assigned

Dec 4, 2013

Last updated

May 30, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

SRSO LLCAs reported in NPPES

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

Authorized official

Name

Spencer Robert Samuelian

Title

Manager

Phone

(949) 445-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beacon Healthcare Center Doing business as

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

{
    "created_epoch": "1386115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496102400000",
    "number": "1184055956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 S STONINGTON RD",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926516741",
            "telephone_number": "949-445-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 N SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917901244",
            "telephone_number": "949-445-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRSW LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SRSO LLC",
        "enumeration_date": "2013-12-04",
        "last_updated": "2017-05-30",
        "status": "A",
        "authorized_official_last_name": "SAMUELIAN",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "949-445-1000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2857712",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in West Covina, CA
• Providers in West Covina, 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 May 30, 2017; 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.