Healthcare Provider Details

I. General information

NPI: 1760592190
Provider Name (Legal Business Name): GEM HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S FAIR OAKS AVE
PASADENA CA
91105-2618
US

IV. Provider business mailing address

445 S FAIR OAKS AVE SUITE M10
PASADENA CA
91105-2632
US

V. Phone/Fax

Practice location:
  • Phone: 626-737-0560
  • Fax: 626-737-0562
Mailing address:
  • Phone: 626-304-6900
  • Fax: 626-564-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000034
License Number StateCA

VIII. Authorized Official

Name: MS. GRACE S MERCADO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 626-304-6900