Provider Demographics
NPI:1982773990
Name:LA HUNTINGTON HEALTHCARE LLC
Entity Type:Organization
Organization Name:LA HUNTINGTON HEALTHCARE LLC
Other - Org Name:HUNTINGTON HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEOUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-935-8490
Mailing Address - Street 1:1101 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3112
Mailing Address - Country:US
Mailing Address - Phone:323-935-8490
Mailing Address - Fax:323-935-8494
Practice Address - Street 1:4515 HUNTINGTON DRIVE S.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1940
Practice Address - Country:US
Practice Address - Phone:323-225-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA HUNTINGTON HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
CA970000057314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555865Medicare Oscar/Certification