Provider Demographics
NPI:1174514236
Name:THE SCRIPPS HOME
Entity type:Organization
Organization Name:THE SCRIPPS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-0934
Mailing Address - Street 1:2212 EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3036
Mailing Address - Country:US
Mailing Address - Phone:626-798-0934
Mailing Address - Fax:626-398-9609
Practice Address - Street 1:2212 EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3036
Practice Address - Country:US
Practice Address - Phone:626-798-0934
Practice Address - Fax:626-398-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555407Medicare ID - Type Unspecified