Mar Vista Nursing Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

910000077 Issued in CA

Legal business name

MAR VISTA NURSING CENTER LLC

Practice address

3966 Marcasel Ave
Los Angeles, CA 90066-4616

Phone

(310) 397-2372

Fax

(310) 397-2383

NPI assigned

Mar 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stephen Reissman

Title

Ceo/Chairman

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mar Vista Nursing Center Doing business as

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1972878718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561297",
            "telephone_number": "323-596-2145",
            "fax_number": "323-596-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3966 MARCASEL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900664616",
            "telephone_number": "310-397-2372",
            "fax_number": "310-397-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAR VISTA NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO/CHAIRMAN",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "910000077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55726F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mar Vista Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Mar 13, 2012; 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.