Provider Demographics
NPI:1346221819
Name:WASHINGTON ENTERPRISES III, LLC
Entity Type:Organization
Organization Name:WASHINGTON ENTERPRISES III, LLC
Other - Org Name:ST. ANDREWS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:CHIVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-731-0861
Mailing Address - Street 1:2300 W. WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1445
Mailing Address - Country:US
Mailing Address - Phone:323-731-0861
Mailing Address - Fax:323-735-0616
Practice Address - Street 1:2300 W. WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1445
Practice Address - Country:US
Practice Address - Phone:323-731-0861
Practice Address - Fax:323-735-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18658GMedicaid
CA555218Medicare Oscar/Certification