Provider Demographics
NPI:1841784287
Name:GHC OF UPLAND RCFE, LLC
Entity Type:Organization
Organization Name:GHC OF UPLAND RCFE, LLC
Other - Org Name:HERITAGE COURT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTROCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-241-5600
Mailing Address - Street 1:6 HUTTON CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8762
Mailing Address - Country:US
Mailing Address - Phone:714-241-5600
Mailing Address - Fax:
Practice Address - Street 1:275 GARNET WAY # B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5932
Practice Address - Country:US
Practice Address - Phone:909-204-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE GENERATIONS HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility