Provider Demographics
NPI:1609840115
Name:GRANCARE LLC
Entity Type:Organization
Organization Name:GRANCARE LLC
Other - Org Name:PARKVIEW 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:
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-208-1940
Mailing Address - Street 1:27350 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4429
Mailing Address - Country:US
Mailing Address - Phone:510-783-8150
Mailing Address - Fax:
Practice Address - Street 1:27350 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4429
Practice Address - Country:US
Practice Address - Phone:510-783-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
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
CAZZR06052IMedicaid
CA05-6052Medicare ID - Type Unspecified
CAZZR06052IMedicaid