Country Villa Westwood, a Ca LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

910000123 Issued in CA

Legal business name

COUNTRY VILLA WESTWOOD, A CA LTD

Practice address

12121 Santa Monica Blvd
Los Angeles, CA 90025-2515

Phone

(310) 826-0821

Fax

(310) 207-9311

NPI assigned

Sep 6, 2005

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 Westwood Healthcare Center Doing business as

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396224000000",
    "number": "1750375705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561292",
            "telephone_number": "310-574-3733",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900252515",
            "telephone_number": "310-826-0821",
            "fax_number": "310-207-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA WESTWOOD, A CA LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2014-03-31",
        "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": "910000123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05060H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Westwood Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Country Villa East, L.P.
• Country Villa East, LP
• Country Villa Imperial LLC
• Country Villa Nursing Center, Inc.
• Country Villa Service Corp.
• Kene Counts
• County of Los Angeles
• County of Los Angeles
• County of Los Angeles
• County of Los Angeles

• All providers in Los Angeles, CA
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; 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.