# GHC OF LAKESIDE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Special Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790789170
- **Authorized official:** LOIS MASTROCOLA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (714) 241-5600

## Contact information

- **Practice address:** 11962 WOODSIDE AVE, LAKESIDE, CA 92040-2914
- **Practice address phone:** (619) 561-1222
- **Practice address fax:** (619) 390-9487
- **Mailing address:** 11962 WOODSIDE AVE, LAKESIDE, CA 92040-2914
- **Mailing address phone:** (619) 561-1222
- **Mailing address fax:** (619) 390-9487

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 080000111 | CA | Yes |

## Other

- **Enumeration date:** 06/13/2005
- **Last updated:** 08/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT18594H | — | CA |