Provider Demographics
NPI:1710227996
Name:PLAZA HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:PLAZA HEALTHCARE CENTER, LLC
Other - Org Name:COUNTRY VILLA PLAZA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-574-3733
Mailing Address - Street 1:1209 HEMLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3609
Mailing Address - Country:US
Mailing Address - Phone:714-546-1966
Mailing Address - Fax:714-546-6719
Practice Address - Street 1:1209 HEMLOCK WAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3609
Practice Address - Country:US
Practice Address - Phone:714-546-1966
Practice Address - Fax:714-546-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000168314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05206KMedicaid
CA055206Medicare Oscar/Certification