Basic Information
| Provider Information | |||||||||
| NPI: | 1518175231 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROSSMONT IPG LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9619 CHESAPEAKE DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585654424 | ||||||||
| FaxNumber: | 8585652428 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 MARENGO AVE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194630281 | ||||||||
| FaxNumber: | 6194617736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 8585654424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0800000337 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.