Provider Demographics
NPI:1750633350
Name:PASADENA MEADOWS NURSING CENTER, LP
Entity Type:Organization
Organization Name:PASADENA MEADOWS NURSING CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO OF GENERAL PARTNER
Authorized Official - Prefix:MR
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 1:1141 BEVERLY DRIVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1119
Mailing Address - Country:US
Mailing Address - Phone:310-286-3074
Mailing Address - Fax:310-286-3064
Practice Address - Street 1:1141 S BEVERLY DR
Practice Address - Street 2:FLOOR 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-286-3074
Practice Address - Fax:310-286-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA970000037Medicaid
CA970000037Medicaid