Provider Demographics
NPI:1790194769
Name:GRAND AVENUE HEALTHCARE & WELLNESS CENTRE, LP
Entity type:Organization
Organization Name:GRAND AVENUE HEALTHCARE & WELLNESS CENTRE, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-800-1191
Mailing Address - Street 1:3580 WILSHIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2502
Mailing Address - Country:US
Mailing Address - Phone:323-330-6572
Mailing Address - Fax:866-603-3566
Practice Address - Street 1:1730 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2011
Practice Address - Country:US
Practice Address - Phone:562-597-8817
Practice Address - Fax:562-597-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05077HMedicaid
CA055077Medicare Oscar/Certification