Healthcare Provider Details

I. General information

NPI: 1144405895
Provider Name (Legal Business Name): GHC OF DALY CITY 102
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ESCUELA DR
DALY CITY CA
94015-4003
US

IV. Provider business mailing address

35 ESCUELA DR
DALY CITY CA
94015-4003
US

V. Phone/Fax

Practice location:
  • Phone: 650-994-3200
  • Fax:
Mailing address:
  • Phone: 650-994-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: ROBYNE L WELLBORN
Title or Position: SYSTEMS SUPPORT & TRAINING
Credential:
Phone: 760-315-0984