Provider Demographics
NPI:1972744837
Name:MAYWOOD SKILLED NURSING & WELLNESS CENTRE, LLC
Entity Type:Organization
Organization Name:MAYWOOD SKILLED NURSING & WELLNESS CENTRE, LLC
Other - Org Name:MAYWOOD HEALTHCARE & WELLNESS CENTRE
Other - Org Type:Doing Business As
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 1:5967 W 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2835
Mailing Address - Country:US
Mailing Address - Phone:323-634-1940
Mailing Address - Fax:323-634-1943
Practice Address - Street 1:6025 PINE AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3108
Practice Address - Country:US
Practice Address - Phone:323-634-1940
Practice Address - Fax:323-634-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000116314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT061401Medicaid
CA555130Medicare Oscar/Certification
CA555130Medicare PIN