Provider Demographics
NPI:1720718596
Name:6740 WILBUR AVENUE OPCO LLC
Entity Type:Organization
Organization Name:6740 WILBUR AVENUE OPCO LLC
Other - Org Name:WEST VALLEY SUBACUTE AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVROHOM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-823-3306
Mailing Address - Street 1:6740 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5179
Mailing Address - Country:US
Mailing Address - Phone:818-708-3533
Mailing Address - Fax:
Practice Address - Street 1:6740 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5179
Practice Address - Country:US
Practice Address - Phone:818-708-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility