Provider Demographics
NPI:1518175231
Name:GROSSMONT IPG LTD
Entity Type:Organization
Organization Name:GROSSMONT IPG LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-565-4424
Mailing Address - Street 1:9619 CHESAPEAKE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1394
Mailing Address - Country:US
Mailing Address - Phone:858-565-4424
Mailing Address - Fax:858-565-2428
Practice Address - Street 1:5480 MARENGO AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2408
Practice Address - Country:US
Practice Address - Phone:619-463-0281
Practice Address - Fax:619-461-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0800000337314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility