Healthcare Provider Details

I. General information

NPI: 1073950614
Provider Name (Legal Business Name): GRAND VALLEY HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13524 SHERMAN WAY
VAN NUYS CA
91405-2830
US

IV. Provider business mailing address

13524 SHERMAN WAY
VAN NUYS CA
91405-2830
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-3470
  • Fax:
Mailing address:
  • Phone: 818-786-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000067
License Number StateCA

VIII. Authorized Official

Name: BRENDA MANDELBAUM
Title or Position: PRESIDENT
Credential:
Phone: 562-930-0777