Basic Information
| Provider Information | |||||||||
| NPI: | 1669458790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARAMOUNT MEADOWS NURSING CENTER LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7039 ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907233925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625310990 | ||||||||
| FaxNumber: | 5625319568 | ||||||||
| Practice Location | |||||||||
| Address1: | 7039 ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625310990 | ||||||||
| FaxNumber: | 5625319568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | GRAFF | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | MM | ||||||||
| AuthorizedOfficialTitleorPosition: | P | ||||||||
| AuthorizedOfficialTelephone: | 3102863074 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 940000022 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZT06166J | 05 | CA | MEDICAID |