Provider Demographics
NPI:1144405895
Name:GHC OF DALY CITY 102
Entity Type:Organization
Organization Name:GHC OF DALY CITY 102
Other - Org Name:ST. FRANCIS HEIGHTS CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEMS SUPPORT & TRAINING
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 1:35 ESCUELA DR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4003
Mailing Address - Country:US
Mailing Address - Phone:650-994-3200
Mailing Address - Fax:
Practice Address - Street 1:35 ESCUELA DR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4003
Practice Address - Country:US
Practice Address - Phone:650-994-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05968FMedicaid
CAZZR05968FMedicaid