Provider Demographics
NPI:1760477558
Name:SOUTHLAND MANAGMENT LLC
Entity Type:Organization
Organization Name:SOUTHLAND MANAGMENT LLC
Other - Org Name:SOUTHLAND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:11701 STUDEBAKER RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-7544
Mailing Address - Country:US
Mailing Address - Phone:562-868-9761
Mailing Address - Fax:562-863-0336
Practice Address - Street 1:11701 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-7544
Practice Address - Country:US
Practice Address - Phone:562-868-9761
Practice Address - Fax:562-863-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18696KMedicaid
CA555070Medicare Oscar/Certification