Healthcare Provider Details

I. General information

NPI: 1356975684
Provider Name (Legal Business Name): GHC OF EL CAJON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E BRADLEY AVE
EL CAJON CA
92021-3110
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 619-448-6633
  • Fax:
Mailing address:
  • Phone: 714-241-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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