Basic Information
| Provider Information | |||||||||
| NPI: | 1972721355 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOLDSTAR HEALTHCARE CENTER OF INGLEWOOD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 CENTINELA AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903023215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106744500 | ||||||||
| FaxNumber: | 3106749393 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 CENTINELA AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903023215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106744500 | ||||||||
| FaxNumber: | 3106749393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 06/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOLDNER | ||||||||
| AuthorizedOfficialFirstName: | DOV | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3106744500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 910000024 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.