Healthcare Provider Details

I. General information

NPI: 1487170890
Provider Name (Legal Business Name): GHC OF SAN FRAN 180, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 PINE ST
SAN FRANCISCO CA
94109-4807
US

IV. Provider business mailing address

6 HUTTON CENTRE DR STE 400
SANTA ANA CA
92707-8762
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-8405
  • Fax:
Mailing address:
  • Phone: 714-241-5600
  • Fax: 360-287-8764

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: ROBYNE WELLBORN
Title or Position: IS AND AR TRAINING MANAGER
Credential:
Phone: 760-315-0984