12882 Shackelford Lane Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060000112 Issued in CA

Legal business name

12882 SHACKELFORD LANE INC

Doing business as

GARDEN GROVE CONV HOSPITAL

Practice address

12882 Shackelford LN
Garden Grove, CA 92841-5109

Phone

(714) 638-9470

Fax

(714) 638-4549

NPI assigned

Aug 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rosalie Piacenti Sanchez

Title

Manager

Phone

(562) 930-0777

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GARDEN GROVE CONV HOSPITAL Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1497903868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 E BROADWAY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908031532",
            "telephone_number": "562-930-0777",
            "fax_number": "562-930-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12882 SHACKELFORD LN",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928415109",
            "telephone_number": "714-638-9470",
            "fax_number": "714-638-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12882 SHACKELFORD LANE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-28",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "SANCHEZ",
        "authorized_official_first_name": "ROSALIE",
        "authorized_official_middle_name": "PIACENTI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "562-930-0777"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "060000112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06145H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARDEN GROVE CONV HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.