Provider Demographics
NPI:1275946568
Name:GHC OF KEARNY MESA, LLC
Entity Type:Organization
Organization Name:GHC OF KEARNY MESA, LLC
Other - Org Name:KEARNY MESA CONVALESCENT & NURSING HOME
Other - Org Type:Doing Business As
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 1:7675 FAMILY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5304
Mailing Address - Country:US
Mailing Address - Phone:858-278-8121
Mailing Address - Fax:
Practice Address - Street 1:7675 FAMILY CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5304
Practice Address - Country:US
Practice Address - Phone:858-278-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275946568Medicaid
CA055286Medicare Oscar/Certification