Provider Demographics
NPI:1801547484
Name:GRV A CALIFORNIA CORPORATION
Entity type:Organization
Organization Name:GRV A CALIFORNIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-704-6275
Mailing Address - Street 1:7405 GREENBACK LANE
Mailing Address - Street 2:336
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610
Mailing Address - Country:US
Mailing Address - Phone:916-486-9639
Mailing Address - Fax:916-750-5701
Practice Address - Street 1:509 MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2705
Practice Address - Country:US
Practice Address - Phone:916-713-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility