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General NPI Number Information
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NPI Number | 1770998080
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Entity Type | Organization
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Legal Business Name | GRANDCARE, INC.
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 6101 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-4818
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Country | US
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Telephone | 415-250-2721
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Fax | 916-488-3132
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Provider Business Mailing Address
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Address Line | 6101 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-4818
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Country | US
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Telephone | 415-250-2721
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Fax | 916-488-3132
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES FRANCIS JORDAN
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Credential |
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Telephone | 415-250-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 347005580
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 030000067
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License Number State | CA
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