Healthcare Provider Details

I. General information

NPI: 1154325512
Provider Name (Legal Business Name): GHC OF MODESTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 W RUMBLE RD
MODESTO CA
95350-0154
US

IV. Provider business mailing address

2633 W RUMBLE RD
MODESTO CA
95350-0154
US

V. Phone/Fax

Practice location:
  • Phone: 760-481-5469
  • Fax: 209-577-0366
Mailing address:
  • Phone: 209-577-1001
  • Fax: 209-577-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000240
License Number StateCA

VIII. Authorized Official

Name: LOIS MASTROCOLA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 714-241-5600