Provider Demographics
NPI:1023534443
Name:GHC OF SAN RAFAEL, LLC
Entity Type:Organization
Organization Name:GHC OF SAN RAFAEL, LLC
Other - Org Name:SMITH RANCH NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IS & AR SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-315-0984
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 1:1550 SILVEIRA PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4879
Practice Address - Country:US
Practice Address - Phone:415-499-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility