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General NPI Number Information
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NPI Number | 1063864874
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Entity Type | Organization
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Legal Business Name | GHC OF SAC - SNF LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 2200 GRAMERCY DR
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City | SACRAMENTO
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State | CA
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Zip | 95825-0308
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Country | US
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Telephone | 916-482-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 GRAMERCY DR
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City | SACRAMENTO
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State | CA
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Zip | 95825-0308
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Country | US
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Telephone | 916-482-2200
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | LOIS MASTROCOLA
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Credential |
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Telephone | 714-241-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 030000403
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License Number State | CA
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