Provider Demographics
NPI:1417208109
Name:SAN RAFAEL HEALTHCARE & WELLNESS CENTRE, LP
Entity Type:Organization
Organization Name:SAN RAFAEL HEALTHCARE & WELLNESS CENTRE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-634-1940
Mailing Address - Street 1:5900 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5013
Mailing Address - Country:US
Mailing Address - Phone:323-330-6500
Mailing Address - Fax:866-603-3566
Practice Address - Street 1:1601 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1808
Practice Address - Country:US
Practice Address - Phone:415-456-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000353314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05331JMedicaid
CA055331Medicare Oscar/Certification