Provider Demographics
NPI:1942204318
Name:GHC OF NEWPORT BEACH, LLC
Entity Type:Organization
Organization Name:GHC OF NEWPORT BEACH, LLC
Other - Org Name:NEWPORT NURSING & REHABILITATION CENTER
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:
Authorized Official - Phone:714-241-5600
Mailing Address - Street 1:1555 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3628
Mailing Address - Country:US
Mailing Address - Phone:949-646-7764
Mailing Address - Fax:949-574-5633
Practice Address - Street 1:1555 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3628
Practice Address - Country:US
Practice Address - Phone:949-646-7764
Practice Address - Fax:949-574-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000116314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC05518GMedicaid
CA5029950001Medicare NSC
CALTC05518GMedicaid