Provider Demographics
NPI:1053020453
Name:GHC OF ANBERRY LLC
Entity type:Organization
Organization Name:GHC OF ANBERRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTROCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-241-5600
Mailing Address - Street 1:6 HUTTON CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8762
Mailing Address - Country:US
Mailing Address - Phone:714-241-5600
Mailing Address - Fax:
Practice Address - Street 1:1685 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4456
Practice Address - Country:US
Practice Address - Phone:209-357-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility