Provider Demographics
NPI:1801836622
Name:GOLDSTAR HEALTHCARE CENTER OF SANTA MONICA, LLC
Entity Type:Organization
Organization Name:GOLDSTAR HEALTHCARE CENTER OF SANTA MONICA, LLC
Other - Org Name:OCEANVIEW CONVALESCENT HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:323-610-3655
Mailing Address - Street 1:1340 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1802
Mailing Address - Country:US
Mailing Address - Phone:310-451-9706
Mailing Address - Fax:310-451-0369
Practice Address - Street 1:1340 15TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1802
Practice Address - Country:US
Practice Address - Phone:310-451-9706
Practice Address - Fax:310-451-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC06334GOtherMEDICAL SNF
CALTC70153FOtherMEDICAL SUB-ACUTE
CA9132324/8371735Medicare UPIN
CA056334Medicare Oscar/Certification