Provider Demographics
NPI:1508862798
Name:MEK LONG BEACH, LLC
Entity Type:Organization
Organization Name:MEK LONG BEACH, LLC
Other - Org Name:REGENCY OAKS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-6200
Mailing Address - Street 1:1506 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3316
Mailing Address - Country:US
Mailing Address - Phone:818-247-6200
Mailing Address - Fax:818-247-7129
Practice Address - Street 1:3850 E ESTHER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2009
Practice Address - Country:US
Practice Address - Phone:562-498-3368
Practice Address - Fax:562-494-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000065314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05197KMedicaid
CA05D0891347OtherCLIA ID NUMBER
CA05D0891347OtherCLIA ID NUMBER
CA056378Medicare Oscar/Certification