Provider Demographics
NPI:1609047117
Name:HIGHLAND PARK SKILLED NURSING & WELLNESS CENTRE, LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK SKILLED NURSING & WELLNESS CENTRE, LLC
Other - Org Name:HIGHLAND PARK SKILLED NURSING & WELLNESS CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-800-1191
Mailing Address - Street 1:5125 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3931
Mailing Address - Country:US
Mailing Address - Phone:323-254-6125
Mailing Address - Fax:323-254-0293
Practice Address - Street 1:5125 MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3931
Practice Address - Country:US
Practice Address - Phone:323-254-6125
Practice Address - Fax:323-254-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970000058314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55165JMedicaid
CA555165Medicare PIN
CA555165Medicare Oscar/Certification