Provider Demographics
NPI:1740492701
Name:WESTSIDE HEALTH CARE, LLC
Entity type:Organization
Organization Name:WESTSIDE HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-938-2451
Mailing Address - Street 1:1020 S FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4401
Mailing Address - Country:US
Mailing Address - Phone:323-938-2451
Mailing Address - Fax:323-938-0361
Practice Address - Street 1:1020 S FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4401
Practice Address - Country:US
Practice Address - Phone:323-938-2451
Practice Address - Fax:323-938-0361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY NURSING HOME MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740492701Medicaid
CALTC55139FMedicaid
CA1740492701Medicaid
=========OtherTAX I.D.