Organization
GRAND TERRACE HEALTH CARE, INC.
Active
Other names
GRAND TERRACE CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MARC JOHNSON (CFO)
(949) 373-8373
Entity
Organization
Contact information
Practice address
12000 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5174
(909) 825-5221
Mailing address
25910 ACERO STE 350, MISSION VIEJO, CA 92691-7908
(949) 441-9258
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
240000143
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05129J
—
CA
Enumeration date
12/09/2005
Last updated
04/05/2024
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