Healthcare Provider Details

I. General information

NPI: 1982608303
Provider Name (Legal Business Name): GHC OF SUNNYVALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 E FREMONT AVE
SUNNYVALE CA
94087-2805
US

IV. Provider business mailing address

797 E FREMONT AVE
SUNNYVALE CA
94087-2805
US

V. Phone/Fax

Practice location:
  • Phone: 408-738-4880
  • Fax: 408-738-1946
Mailing address:
  • Phone: 408-738-4880
  • Fax: 408-738-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000428
License Number StateCA

VIII. Authorized Official

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