Provider Demographics
NPI:1548684467
Name:2210 SANTA ANA OPCO, LLC
Entity type:Organization
Organization Name:2210 SANTA ANA OPCO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANACHEM
Authorized Official - Middle Name:MENDEL
Authorized Official - Last Name:GASTWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-915-4900
Mailing Address - Street 1:11440 VENTURA BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3154
Mailing Address - Country:US
Mailing Address - Phone:818-985-6600
Mailing Address - Fax:
Practice Address - Street 1:2210 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3802
Practice Address - Country:US
Practice Address - Phone:818-985-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT055330JMedicaid
CA055330Medicare Oscar/Certification