Healthcare Provider Details

I. General information

NPI: 1235133687
Provider Name (Legal Business Name): GHC OF NATIONAL CITY I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 SOUTH EUCLID AVE
NATIONAL CITY CA
91950-3808
US

IV. Provider business mailing address

902 SOUTH EUCLID AVE
NATIONAL CITY CA
91950-3808
US

V. Phone/Fax

Practice location:
  • Phone: 619-791-7700
  • Fax: 619-791-7791
Mailing address:
  • Phone: 619-791-7700
  • Fax: 619-791-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090000049
License Number StateCA

VIII. Authorized Official

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