Provider Demographics
NPI:1891980876
Name:LIFEHOUSE PARKVIEW OPERATIONS, LLC
Entity Type:Organization
Organization Name:LIFEHOUSE PARKVIEW OPERATIONS, LLC
Other - Org Name:PARKVIEW HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:310-337-1929
Mailing Address - Street 1:1000 CORPORATE POINTE
Mailing Address - Street 2:STE 100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230
Mailing Address - Country:US
Mailing Address - Phone:310-337-1929
Mailing Address - Fax:310-348-9105
Practice Address - Street 1:329 N. REAL RD.
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-327-7107
Practice Address - Fax:661-327-3943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE PARKVIEW OPERATIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555336Medicare Oscar/Certification