Provider Demographics
NPI:1831198142
Name:GRASS VALLEY CARE CENTER, INC.
Entity type:Organization
Organization Name:GRASS VALLEY CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-624-6230
Mailing Address - Street 1:4020 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE #190
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3906
Mailing Address - Country:US
Mailing Address - Phone:916-624-6230
Mailing Address - Fax:916-624-6242
Practice Address - Street 1:107 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5705
Practice Address - Country:US
Practice Address - Phone:530-273-4447
Practice Address - Fax:530-273-6849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORIZON WEST HEALTHCARE OF CALIFORNIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000134314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05512HMedicaid
CAZZR05512HMedicaid
CA055512Medicare Oscar/Certification