Healthcare Provider Details

I. General information

NPI: 1598575276
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1908
US

IV. Provider business mailing address

12601 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1908
US

V. Phone/Fax

Practice location:
  • Phone: 714-741-2700
  • Fax: 714-741-3370
Mailing address:
  • Phone: 714-741-2700
  • Fax: 714-741-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706