Provider Demographics
NPI:1588660369
Name:FAMILY HEALTH & HOUSING FOUNDATION
Entity Type:Organization
Organization Name:FAMILY HEALTH & HOUSING FOUNDATION
Other - Org Name:SUNNYSIDE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-320-4130
Mailing Address - Street 1:22617 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2550
Mailing Address - Country:US
Mailing Address - Phone:310-320-4130
Mailing Address - Fax:310-212-3232
Practice Address - Street 1:22617 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2595
Practice Address - Country:US
Practice Address - Phone:310-320-4130
Practice Address - Fax:310-212-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000106314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05159JMedicaid
CAZZT05159JMedicaid
CAZZZM6488ZOtherBLUE SHIELD HMO PROVIDER
CA4296150001Medicare NSC
CA056488Medicare ID - Type UnspecifiedMEDICARE PROVIDER
CAZZT05159JMedicaid