Healthcare Provider Details

I. General information

NPI: 1053143628
Provider Name (Legal Business Name): GHC OF CLAREMONT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S COLLEGE AVE
CLAREMONT CA
91711-5527
US

IV. Provider business mailing address

6 HUTTON CENTRE DR STE 400
SANTA ANA CA
92707-8762
US

V. Phone/Fax

Practice location:
  • Phone: 956-452-1554
  • Fax:
Mailing address:
  • Phone: 714-241-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOIS MASTROCOLA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 714-241-5600