Provider Demographics
NPI:1871670083
Name:GRANADA HILLS CONVALESCENT HOSPITAL, INC
Entity Type:Organization
Organization Name:GRANADA HILLS CONVALESCENT HOSPITAL, INC
Other - Org Name:GRANADA HILLS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:818-891-1745
Mailing Address - Street 1:16123 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-891-1745
Mailing Address - Fax:818-891-1747
Practice Address - Street 1:16123 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-891-1745
Practice Address - Fax:818-891-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000038314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA206190349/ZZT06168Medicaid
CA920000038OtherDEPT OF PUBLIC HEALTH
CAZZT 06168HMedicaid
CAZZT 06168HMedicaid