Healthcare Provider Details

I. General information

NPI: 1871670083
Provider Name (Legal Business Name): GRANADA HILLS CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16123 CHATSWORTH ST
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

16123 CHATSWORTH ST
GRANADA HILLS CA
91344
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-1745
  • Fax: 818-891-1747
Mailing address:
  • Phone: 818-891-1745
  • Fax: 818-891-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000038
License Number StateCA

VIII. Authorized Official

Name: MR. KENNETH GOLDBLATT
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 818-891-1745