Provider Demographics
NPI:1477909125
Name:PALMCREST GRAND HOME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:PALMCREST GRAND HOME ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:STREICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-828-7822
Mailing Address - Street 1:181 N LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1047
Mailing Address - Country:US
Mailing Address - Phone:323-828-7822
Mailing Address - Fax:562-426-1099
Practice Address - Street 1:3503 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3809
Practice Address - Country:US
Practice Address - Phone:562-595-4551
Practice Address - Fax:562-490-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198602069310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility