Provider Demographics
NPI:1548232150
Name:GRANCARE LLC
Entity Type:Organization
Organization Name:GRANCARE LLC
Other - Org Name:DRIFTWOOD HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL FINANCIAL ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:707-208-1940
Mailing Address - Street 1:675 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4205
Mailing Address - Country:US
Mailing Address - Phone:831-475-6323
Mailing Address - Fax:
Practice Address - Street 1:675 24TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4205
Practice Address - Country:US
Practice Address - Phone:831-475-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05109HMedicaid
CAN/AMedicare UPIN
CA05-5109Medicare ID - Type Unspecified