Healthcare Provider Details

I. General information

NPI: 1003734849
Provider Name (Legal Business Name): GRAND PARK SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 W 8TH ST
LOS ANGELES CA
90057-3906
US

IV. Provider business mailing address

990 E DEL MAR BLVD
PASADENA CA
91106-3252
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-6152
  • Fax:
Mailing address:
  • Phone: 626-793-6152
  • Fax:

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: MR. STEVEN BERGER
Title or Position: MANAGER
Credential:
Phone: 626-793-6152