Basic Information
| Provider Information | |||||||||
| NPI: | 1023534443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GHC OF SAN RAFAEL, LLC | ||||||||
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| OtherOrganizationName: | SMITH RANCH NURSING & REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 HUTTON CENTRE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927078762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142415600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1550 SILVEIRA PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949034879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154991000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | WELLBORN | ||||||||
| AuthorizedOfficialFirstName: | ROBYNE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | IS & AR SYSTEMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7603150984 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.