Grand Terrace Health Care, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000143 Issued in CA

Legal business name

GRAND TERRACE HEALTH CARE, INC.

Doing business as

Grand Terrace Care Center

Practice address

12000 Mount Vernon Ave
Grand Terrace, CA 92313-5174

Phone

(909) 825-5221

NPI assigned

Dec 9, 2005

Last updated

Apr 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marc Johnson

Title

Cfo

Phone

(949) 373-8373

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GRAND TERRACE CARE CENTER Doing business as

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1811972193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25910 ACERO STE 350",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917908",
            "telephone_number": "949-441-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135174",
            "telephone_number": "909-825-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TERRACE HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-09",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-373-8373"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05129J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND TERRACE CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRAND TERRACE CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Grand Terrace, CA
• Providers in Grand Terrace, 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 Apr 5, 2024; 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.