Provider Demographics
NPI:1679546915
Name:GRANCARE LLC
Entity Type:Organization
Organization Name:GRANCARE LLC
Other - Org Name:DRIFTWOOD HEALTHCARE CENTER - TORRANCE
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 1:4109 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3105
Mailing Address - Country:US
Mailing Address - Phone:310-371-4628
Mailing Address - Fax:
Practice Address - Street 1:4109 EMERALD ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3105
Practice Address - Country:US
Practice Address - Phone:310-371-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
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
CAZZT06034HMedicaid
CA55-5114Medicare ID - Type Unspecified
CAN/AMedicare UPIN