Provider Demographics
NPI:1407499163
Name:WEST GARDENA CARE CENTER LLC
Entity Type:Organization
Organization Name:WEST GARDENA CARE CENTER LLC
Other - Org Name:WEST GARDENA POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHONOCH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-329-9929
Mailing Address - Street 1:6442 COLDWATER CANYON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1191
Mailing Address - Country:US
Mailing Address - Phone:310-329-9929
Mailing Address - Fax:
Practice Address - Street 1:16530 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-2714
Practice Address - Country:US
Practice Address - Phone:917-842-8361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility