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General NPI Number Information
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NPI Number | 1134494826
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Entity Type | Organization
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Legal Business Name | GRANITE HILLS CONVALESCENT HOSPITAL
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 1340 E MADISON AVE
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City | EL CAJON
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State | CA
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Zip | 92021-8501
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Country | US
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Telephone | 619-447-1020
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Fax | 619-447-1024
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Provider Business Mailing Address
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Address Line | 1340 E MADISON AVE
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City | EL CAJON
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State | CA
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Zip | 92021-8501
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Country | US
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Telephone | 619-447-1020
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Fax | 619-447-1024
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Authorized Official
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Title or Position | INTERIM MANAGER
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Name | MR. LARRY BLITZ
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Credential |
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Telephone | 619-447-1020
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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 | 090000097
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License Number State | CA
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