MEDICARE: GHC OF NATIONAL CITY I, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	090000049	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235133687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHC OF NATIONAL CITY I, LLC

Provider Business Mailing Address
First Line	:	902 SOUTH EUCLID AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3808
Country	:	US
Telephone Number	:	619-791-7700
Fax Number	:	619-791-7791

Provider Business Practice Location Address
First Line	:	902 SOUTH EUCLID AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3808
Country	:	US
Telephone Number	:	619-791-7700
Fax Number	:	619-791-7791

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	LOIS MASTROCOLA
Credential	:
Telephone Number	:	714-241-5600

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/05/2024

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