Healthcare Provider Details

I. General information

NPI: 1306824248
Provider Name (Legal Business Name): GRANADA HEALTHCARE & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 HARRIS ST
EUREKA CA
95503-4808
US

IV. Provider business mailing address

2885 HARRIS ST
EUREKA CA
95503-4808
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-1627
  • Fax:
Mailing address:
  • Phone: 707-443-1627
  • 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: MS. DEVIN SHELBY
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-443-1627