Basic Information
| Provider Information | |||||||||
| NPI: | 1801089537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROSSMONT GARDENS OPERATIONS, LLC | ||||||||
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| OtherOrganizationName: | GROSSMONT GARDENS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9510 ORMSBY STATION RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027536004 | ||||||||
| FaxNumber: | 5027536104 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 MARENGO AVE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194630281 | ||||||||
| FaxNumber: | 6194617736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | BARBER | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5027536004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | CA | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.