Healthcare Provider Details

I. General information

NPI: 1275946568
Provider Name (Legal Business Name): GHC OF KEARNY MESA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 FAMILY CIR
SAN DIEGO CA
92111-5304
US

IV. Provider business mailing address

7675 FAMILY CIR
SAN DIEGO CA
92111-5304
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8121
  • Fax:
Mailing address:
  • Phone: 858-278-8121
  • 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: LOIS MASTROCOLA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 714-241-5600