Provider Demographics
NPI:1831476365
Name:HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP
Entity Type:Organization
Organization Name:HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-800-1191
Mailing Address - Street 1:11630 GREVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2231
Mailing Address - Country:US
Mailing Address - Phone:310-679-9732
Mailing Address - Fax:310-679-3672
Practice Address - Street 1:11630 GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2231
Practice Address - Country:US
Practice Address - Phone:310-679-9732
Practice Address - Fax:310-679-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA900000063314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55677FMedicaid
CALTC55677FMedicaid