Provider Demographics
NPI:1154359586
Name:KTLA PROPERTIES LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:KTLA PROPERTIES LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8060
Practice Address - Street 1:3902 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3304
Practice Address - Country:US
Practice Address - Phone:562-596-5561
Practice Address - Fax:562-596-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000076314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06169GMedicaid
CA206301089OtherOSHPD FACILITY NUMBER
CA206301089OtherOSHPD FACILITY NUMBER
CAZZT06169GMedicaid