1942204318 NPI number — GHC OF NEWPORT BEACH, LLC

Table of content: (NPI 1942204318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942204318 NPI number — GHC OF NEWPORT BEACH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GHC OF NEWPORT BEACH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEWPORT NURSING & REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942204318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 SUPERIOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-646-7764
Provider Business Mailing Address Fax Number:
949-574-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-646-7764
Provider Business Practice Location Address Fax Number:
949-574-5633
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MASTROCOLA
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
714-241-5600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060000116 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LTC05518G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com