Provider Demographics
NPI:1932104213
Name:BIXBY KNOLLS TOWERS, INC
Entity Type:Organization
Organization Name:BIXBY KNOLLS TOWERS, INC
Other - Org Name:BIXBY KNOLLS HEALTH CARE & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5100
Mailing Address - Street 1:3747 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3428
Mailing Address - Country:US
Mailing Address - Phone:562-426-6123
Mailing Address - Fax:562-426-1506
Practice Address - Street 1:3747 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3428
Practice Address - Country:US
Practice Address - Phone:562-426-6123
Practice Address - Fax:562-426-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06283FMedicaid
CA056283Medicare ID - Type UnspecifiedMEDICARE ID