Provider Demographics
NPI:1811552359
Name:ODELIA HEALTHCARE LLC
Entity Type:Organization
Organization Name:ODELIA HEALTHCARE LLC
Other - Org Name:CAMINO HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-405-3399
Mailing Address - Street 1:4525 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3846
Mailing Address - Country:US
Mailing Address - Phone:323-405-3399
Mailing Address - Fax:
Practice Address - Street 1:1509 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1708
Practice Address - Country:US
Practice Address - Phone:505-243-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility