# GROSS CONVALESCENT HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WINE COUNTRY CARE CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053311225
- **Authorized official:** MR. PAUL G GROSS M.A. (ADMINISTRATOR/CEO)
- **Authorized official phone:** (209) 334-3760

## Contact information

- **Practice address:** 321 W TURNER RD, LODI, CA 95240-0517
- **Practice address phone:** (209) 334-3760
- **Practice address fax:** (209) 334-1071
- **Mailing address:** 321 W TURNER RD, LODI, CA 95240-0517
- **Mailing address phone:** (209) 334-3760
- **Mailing address fax:** (209) 334-1071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 07/28/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR05289F | — | CA |