Provider Demographics
NPI:1811211915
Name:ADVANCED SKILLED NURSING INC.
Entity Type:Organization
Organization Name:ADVANCED SKILLED NURSING INC.
Other - Org Name:VIRGIL REHABILITATION AND SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUSTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-0509
Mailing Address - Street 1:975 NORTH VIRGIL AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029
Mailing Address - Country:US
Mailing Address - Phone:323-665-5793
Mailing Address - Fax:323-665-2683
Practice Address - Street 1:975 NORTH VIRGIL AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:323-665-5793
Practice Address - Fax:323-665-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
CA055157314000000X
CAZZT05157F314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05157FMedicaid
CAZZT05157FMedicaid