Provider Demographics
NPI:1013641562
Name:EAST LOS ANGELES HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EAST LOS ANGELES HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:262 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2975
Mailing Address - Country:US
Mailing Address - Phone:801-447-9823
Mailing Address - Fax:
Practice Address - Street 1:1016 S RECORD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2533
Practice Address - Country:US
Practice Address - Phone:323-268-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility