Organization
GROSS CONVALESCENT HOSPITAL, INC
Active
Other names
WINE COUNTRY CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL G GROSS M.A. (ADMINISTRATOR/CEO)
(209) 334-3760
Entity
Organization
Contact information
Practice address
321 W TURNER RD, LODI, CA 95240-0517
(209) 334-3760
(209) 334-1071
Mailing address
321 W TURNER RD, LODI, CA 95240-0517
(209) 334-3760
(209) 334-1071
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05289F
—
CA
Enumeration date
07/28/2005
Last updated
08/22/2020
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