Provider Demographics
NPI:1922147685
Name:MARLINDA WEST NURSING HOME
Entity Type:Organization
Organization Name:MARLINDA WEST NURSING HOME
Other - Org Name:BEECHWOOD PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASSOUMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-638-6691
Mailing Address - Street 1:3351 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3305
Mailing Address - Country:US
Mailing Address - Phone:310-638-6691
Mailing Address - Fax:
Practice Address - Street 1:3358 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3302
Practice Address - Country:US
Practice Address - Phone:310-638-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001334315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80302FMedicaid