Healthcare Provider Details

I. General information

NPI: 1366627929
Provider Name (Legal Business Name): GHC OF DALY CITY 102, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 08/05/2014
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: 650-755-9515
  • Fax: 650-755-2154
Mailing address:
  • Phone: 650-755-9515
  • Fax: 650-755-2154

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: LOIS MASTROCOLA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 650-755-9515