Provider Demographics
NPI:1457659682
Name:GLADIOLUS HOLDINGS, LLC
Entity Type:Organization
Organization Name:GLADIOLUS HOLDINGS, LLC
Other - Org Name:THE PINES AT PLACERVILLE HEALTHCARE CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:2175 SALK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7346
Mailing Address - Country:US
Mailing Address - Phone:760-471-0388
Mailing Address - Fax:760-471-0311
Practice Address - Street 1:1040 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5706
Practice Address - Country:US
Practice Address - Phone:530-622-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457659682Medicaid
CA055497Medicare Oscar/Certification