Healthcare Provider Details

I. General information

NPI: 1508953662
Provider Name (Legal Business Name): GRANITE HILLS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
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 Number
License Number StateCA

VIII. Authorized Official

Name: MR. GARY D DEVOIR
Title or Position: PRESIDENT
Credential:
Phone: 619-447-1020