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General NPI Number Information
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NPI Number | 1417036518
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Entity Type | Organization
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Legal Business Name | GRANADA CARE INC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2385 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806
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Country | US
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Telephone | 562-426-7772
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Fax | 562-426-0797
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Provider Business Mailing Address
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Address Line | 2385 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806
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Country | US
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Telephone | 562-426-7772
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Fax | 562-426-0797
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MR. LEVI RAICHIX
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Credential |
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Telephone | 562-426-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | CA
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