Country Villa East, L.P.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

920000065 Issued in CA

Legal business name

COUNTRY VILLA EAST, L.P.

Doing business as

Country Villa Sheraton Nursing Center

Practice address

9655 Sepulveda Blvd
North Hills, CA 91343-3307

Phone

(818) 892-8665

Fax

(818) 891-1208

NPI assigned

Sep 6, 2005

Last updated

Sep 7, 2022By 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. Stephen E. Reissman

Title

Managing Member of General Partner

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Sheraton Nursing Center Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1538153572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EXCHANGE STE 140",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926021343",
            "telephone_number": "714-673-6870",
            "fax_number": "949-954-6373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9655 SEPULVEDA BLVD",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913433307",
            "telephone_number": "818-892-8665",
            "fax_number": "818-891-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA EAST, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MANAGING MEMBER OF GENERAL PARTNER",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "920000065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18676I",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "284 Merchant St",
            "city": "Ste Genevieve",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636701610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Country Villa Sheraton Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Villa Sheraton Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joaquin Alberto Cornejo
• Alan Cortes Quintanilla
• Lynda Jailene Cortes
• William E Corzo
• Darren James Cosby, B.A. SOCIAL WORK
• John Cox Jr., LMFT
• Julia Craciun
• Katrina Crenshaw-Upah, PHD, PHD
• Carlos Cruz
• Mark Cromwell Cruz, M.A.

• Skilled Nursing Facility in North Hills, CA
• Providers in North Hills, 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 Sep 7, 2022; 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.