Healthcare Provider Details

I. General information

NPI: 1063864874
Provider Name (Legal Business Name): GHC OF SAC - SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GRAMERCY DR
SACRAMENTO CA
95825-0308
US

IV. Provider business mailing address

2200 GRAMERCY DR
SACRAMENTO CA
95825-0308
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-2200
  • Fax:
Mailing address:
  • Phone: 916-482-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000403
License Number StateCA

VIII. Authorized Official

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