Provider Demographics
NPI: | 1487192134 |
---|---|
Name: | NURSING & REHAB AT RAYMORE LLC |
Entity Type: | Organization |
Organization Name: | NURSING & REHAB AT RAYMORE LLC |
Other - Org Name: | REDWOOD OF RAYMORE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SOLOMON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GURWITZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 323-405-3377 |
Mailing Address - Street 1: | 4601 WILSHIRE BLVD |
Mailing Address - Street 2: | SUITE 220 |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90010-3880 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-405-3377 |
Mailing Address - Fax: | 323-900-0285 |
Practice Address - Street 1: | 600 E SUNRISE DR |
Practice Address - Street 2: | |
Practice Address - City: | RAYMORE |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64083-9037 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-322-1991 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | RED WOOD HEALTHCARE GROUP LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-02-02 |
Last Update Date: | 2017-03-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |