Healthcare Provider Details

I. General information

NPI: 1083618441
Provider Name (Legal Business Name): GHC OF LOS GATOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 SAMARITAN DR
SAN JOSE CA
95124-4101
US

IV. Provider business mailing address

2580 SAMARITAN DR
SAN JOSE CA
95124-4101
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-8181
  • Fax: 408-356-1851
Mailing address:
  • Phone: 408-356-8181
  • Fax: 408-356-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000080
License Number StateCA

VIII. Authorized Official

Name: THOMAS OLDS JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 714-241-5600