Provider Demographics
NPI:1073767273
Name:BROKHIM, LLC
Entity Type:Organization
Organization Name:BROKHIM, LLC
Other - Org Name:WILSHIRE VISTA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-933-8271
Mailing Address - Street 1:1015 S ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6510
Mailing Address - Country:US
Mailing Address - Phone:323-933-8271
Mailing Address - Fax:323-933-8273
Practice Address - Street 1:1015 S ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6510
Practice Address - Country:US
Practice Address - Phone:323-933-8271
Practice Address - Fax:323-933-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607392311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility