MEDICARE: GRANCARE LLC

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982676524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANCARE LLC

Provider Business Mailing Address
First Line	:	44610 MONTEREY AVE
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3326
Country	:	US
Telephone Number	:	760-773-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	44610 MONTEREY AVE
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3326
Country	:	US
Telephone Number	:	760-773-5151
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL FINANCIAL ANALYST
Name	:	MRS. ANDREA SAAVEDRA
Credential	:
Telephone Number	:	707-208-1940

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	08/22/2020

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Directions to “GRANCARE LLC ” Practice Location

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