Provider Demographics
NPI:1356877609
Name:GRANADA POST ACUTE LP
Entity type:Organization
Organization Name:GRANADA POST ACUTE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-786-3470
Mailing Address - Street 1:3565 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2654
Mailing Address - Country:US
Mailing Address - Phone:310-638-9377
Mailing Address - Fax:310-632-8315
Practice Address - Street 1:3565 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2654
Practice Address - Country:US
Practice Address - Phone:310-638-9377
Practice Address - Fax:310-632-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55348GMedicaid
CALTC55348GMedicaid