Provider Demographics
NPI:1326477159
Name:THE BREAKERS OF LONG BEACH INC.
Entity Type:Organization
Organization Name:THE BREAKERS OF LONG BEACH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-713-0155
Mailing Address - Street 1:22900 VENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1279
Mailing Address - Country:US
Mailing Address - Phone:818-713-0155
Mailing Address - Fax:818-713-8266
Practice Address - Street 1:210 E OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4853
Practice Address - Country:US
Practice Address - Phone:562-432-6700
Practice Address - Fax:562-435-0544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGN OF THE DOVE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197801971310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility