Ghc Of Lakeside, LLC
Skilled Nursing Facility in Lakeside, CA. Organization (NPI-2).
NPI number1790789170
StatusActive
Last updated in NPPESAug 5, 2024
Details
- NPI
- 1790789170
- Entity type
- Organization (NPI-2)
- Legal business name
- Ghc Of Lakeside, LLC
- Organization subpart
- No
- Enumeration date
- Jun 13, 2005
- Certification date
- Aug 1, 2024
- Last updated
- Aug 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | 080000111 | CA | Yes |
Other names
- Lakeside Special Care Center (Doing Business As)
Practice location
11962 Woodside AveLakeside, CA 92040-2914
Phone 619-561-1222 · Fax 619-390-9487
Mailing address
11962 Woodside AveLakeside, CA 92040-2914
Phone 619-561-1222 · Fax 619-390-9487
Authorized official
Lois Mastrocola
Chief Financial Officer
7142415600
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