Basic Information
| Provider Information | |||||||||
| NPI: | 1881153526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EC OPCO GROSSMONT GARDENS, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 MEADOWS RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712541368 | ||||||||
| FaxNumber: | 8662469514 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 MARENGO AVE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194630281 | ||||||||
| FaxNumber: | 6194638394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9713373922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.