=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871670083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANADA HILLS CONVALESCENT HOSPITAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16123 CHATSWORTH ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-891-1745
-----------------------------------------------------
Fax | 818-891-1747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16123 CHATSWORTH ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-891-1745
-----------------------------------------------------
Fax | 818-891-1747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. KENNETH GOLDBLATT
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 818-891-1745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 920000038
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------