Provider Demographics
NPI:1124134572
Name:SILVERSCREEN HEALTHCARE
Entity type:Organization
Organization Name:SILVERSCREEN HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-987-7735
Mailing Address - Street 1:10830 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-5021
Mailing Address - Country:US
Mailing Address - Phone:818-763-8247
Mailing Address - Fax:818-762-8279
Practice Address - Street 1:10830 OXNARD ST
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-5021
Practice Address - Country:US
Practice Address - Phone:818-763-8247
Practice Address - Fax:818-762-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000036314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18128HMedicaid
CA555011Medicare Oscar/Certification