# GLENDORA GRAND, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497077739
- **Authorized official:** MS. VICKI P ROLLINS RN (VICE-PRESIDENT)
- **Authorized official phone:** (626) 331-0781

## Contact information

- **Practice address:** 805 W. ARROW HIGHWAY, GLENDORA, CA 91740-5413
- **Practice address phone:** (626) 331-0781
- **Practice address fax:** (626) 332-8835
- **Mailing address:** 805 W. ARROW HIGHWAY, GLENDORA, CA 91740-5413
- **Mailing address phone:** (626) 331-0781
- **Mailing address fax:** (626) 332-8835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 950000079 | CA | Yes |

## Other

- **Enumeration date:** 02/26/2010
- **Last updated:** 03/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 950000079 | — | CA |