Provider Demographics
NPI:1669458790
Name:PARAMOUNT MEADOWS NURSING CENTER LP
Entity Type:Organization
Organization Name:PARAMOUNT MEADOWS NURSING CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:MM
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-286-3074
Mailing Address - Street 1:7039 ALONDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3925
Mailing Address - Country:US
Mailing Address - Phone:562-531-0990
Mailing Address - Fax:562-531-9568
Practice Address - Street 1:7039 ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723
Practice Address - Country:US
Practice Address - Phone:562-531-0990
Practice Address - Fax:562-531-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000022314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06166JMedicaid
CA056166Medicare Oscar/Certification