MEDICARE: THE PALMCREST GRAND CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	940000130	CA

General Provider Information

NPI Number	:	1710070370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PALMCREST GRAND CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	3501 CEDAR AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3809
Country	:	US
Telephone Number	:	562-595-1731
Fax Number	:	562-426-1099

Provider Business Practice Location Address
First Line	:	3501 CEDAR AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3809
Country	:	US
Telephone Number	:	562-595-1731
Fax Number	:	562-426-1099

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MS. VICKI P. ROLLINS
Credential	:	R.N.
Telephone Number	:	562-595-1731

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/03/2010

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