Country Villa Park Marino Healthcare Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000088 Issued in CA

Legal business name

COUNTRY VILLA PARK MARINO HEALTHCARE CENTER, LLC

Doing business as

Country Villa Park Marino Healthcare Center

Practice address

2585 E Washington Blvd
Pasadena, CA 91107-1446

Phone

(626) 463-4105

Fax

(626) 798-5121

NPI assigned

Sep 13, 2005

Last updated

Jan 20, 2009By 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

President of CVHS, Manager

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Park Marino Healthcare Center Doing business as

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232409600000",
    "number": "1811982176",
    "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": "2585 E WASHINGTON BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071446",
            "telephone_number": "626-463-4105",
            "fax_number": "626-798-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA PARK MARINO HEALTHCARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-13",
        "last_updated": "2009-01-20",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT OF CVHS, MANAGER",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC05548F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Park Marino Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Liam Robert Costa
• Madison Costa
• William M Costigan, M.D.
• Alvaro Reynaldo Cota
• Andrew Cotham, PT
• Amy Cousineau, PH.D.
• Caroline Couto
• Azahel Covarrubias II
• Javier Covarrubias
• Norma Rosa Covarrubias

• Skilled Nursing Facility in Pasadena, CA
• Providers in Pasadena, 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 Jan 20, 2009; 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.