Provider Demographics
NPI:1750792941
Name:VERMONT HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:VERMONT HEALTHCARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-933-5763
Mailing Address - Street 1:22035 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2120
Mailing Address - Country:US
Mailing Address - Phone:310-328-0812
Mailing Address - Fax:310-782-3890
Practice Address - Street 1:22035 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2120
Practice Address - Country:US
Practice Address - Phone:310-328-0812
Practice Address - Fax:310-782-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-11
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750792941Medicaid
CA1750792941Medicaid