Provider Demographics
NPI:1972721355
Name:GOLDSTAR HEALTHCARE CENTER OF INGLEWOOD, LLC
Entity Type:Organization
Organization Name:GOLDSTAR HEALTHCARE CENTER OF INGLEWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-674-4500
Mailing Address - Street 1:515 CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3215
Mailing Address - Country:US
Mailing Address - Phone:310-674-4500
Mailing Address - Fax:310-674-9393
Practice Address - Street 1:515 CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3215
Practice Address - Country:US
Practice Address - Phone:310-674-4500
Practice Address - Fax:310-674-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055608Medicare Oscar/Certification