MEDICARE: GHC OF MLK 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1992510796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHC OF MLK LLC

Provider Business Mailing Address
First Line	:	6 HUTTON CENTRE DR STE 400
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-8762
Country	:	US
Telephone Number	:	714-241-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HUTTON CENTRE DR STE 400
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-8762
Country	:	US
Telephone Number	:	714-241-5600
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	LOIS MASTROCOLA
Credential	:
Telephone Number	:	714-241-5600

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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Directions to “GHC OF MLK LLC ” Practice Location

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