Basic Information
| Provider Information | |||||||||
| NPI: | 1922350206 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERN CALIFORNIA HOSPITAL AT CULVER CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3415 S SEPULVEDA BLVD FL 9 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900346060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109434500 | ||||||||
| FaxNumber: | 3109434501 | ||||||||
| Practice Location | |||||||||
| Address1: | 3828 DELMAS TER | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902322713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108367000 | ||||||||
| FaxNumber: | 3102024141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2012 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ELDERS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JON | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7147881249 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 930000066 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.