Healthcare Provider Details

I. General information

NPI: 1134494826
Provider Name (Legal Business Name): GRANITE HILLS CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E MADISON AVE
EL CAJON CA
92021-8501
US

IV. Provider business mailing address

1340 E MADISON AVE
EL CAJON CA
92021-8501
US

V. Phone/Fax

Practice location:
  • Phone: 619-447-1020
  • Fax: 619-447-1024
Mailing address:
  • Phone: 619-447-1020
  • Fax: 619-447-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090000097
License Number StateCA

VIII. Authorized Official

Name: MR. LARRY BLITZ
Title or Position: INTERIM MANAGER
Credential:
Phone: 619-447-1020