Organization
12882 SHACKELFORD LANE INC
Active
Other names
GARDEN GROVE CONV HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
ROSALIE PIACENTI SANCHEZ (MANAGER)
(562) 930-0777
Entity
Organization
Contact information
Practice address
12882 SHACKELFORD LN, GARDEN GROVE, CA 92841-5109
(714) 638-9470
(714) 638-4549
Mailing address
4115 E BROADWAY, LONG BEACH, CA 90803-1532
(562) 930-0777
(562) 930-0728
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
060000112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT06145H
—
CA
Enumeration date
08/28/2008
Last updated
12/08/2010
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