Country Villa East, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COUNTRY VILLA EAST, LP

Doing business as

Country Villa Terrace Assisted Living

Practice address

6050 W Pico Blvd
Los Angeles, CA 90035-2647

Phone

(323) 653-5565

Fax

(323) 782-9516

NPI assigned

Jan 5, 2010

Last updated

Sep 14, 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

Mrs. Cheryl Petterson

Title

Vice President - Cams

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Terrace Assisted Living Doing business as

Locations

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

{
    "created_epoch": "1262649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1801126305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 WILSHIRE BLVD STE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102502",
            "telephone_number": "323-330-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900352647",
            "telephone_number": "323-653-5565",
            "fax_number": "323-782-9516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-05",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "PETTERSON",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "VICE PRESIDENT - CAMS",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801126305",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Terrace Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Villa Terrace Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kurtis Coulter
• Megan Coulter, M.A., PCCI
• Country Villa East L.P. (Country Villa East Healthcare Center)
• Country Villa East L.P. (Country Villa Terrace Healthcare Center)
• Country Villa East, L.P. (Country Villa Pavilion Healthcare Center)
• Country Villa Imperial LLC (Country Villa Los Feliz Healthcare Center)
• Country Villa Nursing Center, Inc. (Country Villa Rehabilitation Center)
• Country Villa Service Corp.
• Country Villa Westwood, a Ca LTD (Country Villa Westwood Healthcare Center)
• Kene Counts

• 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 Sep 14, 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.