Hollywood Care Home, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

HOLLYWOOD CARE HOME, INC.

Practice address

13307 Stagg St
North Hollywood, CA 91605-1736

Phone

(909) 519-3306

NPI assigned

Jun 22, 2020

Last updated

Jun 22, 2020By 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

Mrs. Kyong Suk Lee, PRESIDENT

Title

Administrator

Phone

(909) 618-7575

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1407472707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13307 STAGG ST",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916051736",
            "telephone_number": "909-519-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13307 STAGG ST",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916051736",
            "telephone_number": "909-519-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLYWOOD CARE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KYONG SUK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-618-7575",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; 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.