Provider Demographics
NPI:1568766848
Name:PALMCREST CARE CENTER, LLC
Entity Type:Organization
Organization Name:PALMCREST CARE CENTER, LLC
Other - Org Name:PALMCREST CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-821-3897
Mailing Address - Street 1:3501 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3809
Mailing Address - Country:US
Mailing Address - Phone:562-595-1731
Mailing Address - Fax:562-988-3531
Practice Address - Street 1:3501 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:562-595-1731
Practice Address - Fax:562-988-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-31
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056313Medicare Oscar/Certification