Healthcare Provider Details

I. General information

NPI: 1710070370
Provider Name (Legal Business Name): THE PALMCREST GRAND CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CEDAR AVE
LONG BEACH CA
90807-3809
US

IV. Provider business mailing address

3501 CEDAR AVE
LONG BEACH CA
90807-3809
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-1731
  • Fax: 562-426-1099
Mailing address:
  • Phone: 562-595-1731
  • Fax: 562-426-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000130
License Number StateCA

VIII. Authorized Official

Name: MS. VICKI P. ROLLINS
Title or Position: VICE-PRESIDENT
Credential: R.N.
Phone: 562-595-1731