GRANCELL VILLAGE
NPI 1417950163
Nursing Facility/Intermediate Care Facility in Reseda, CA

Q: What is Grancell Village Of The Los Angeles Jewish Home For The Aging's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Active since May 24, 2005CLIA 05D0694228 · Waiver

7150 TAMPA AVE, RESEDA, CA 91335(818) 774-3000 Get Directions Write a Review

NPPES record last updated: July 22, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Grancell Village NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRANCELL VILLAGE (NPI 1417950163) is a healthcare organization registered as a nursing facility/intermediate care facility in Reseda, California and active in the NPI registry since May 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Mary M Forrest, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1417950163

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameGRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING

Location Address7150 TAMPA AVEReseda, CA 91335-3700

Mailing Address7150 Tampa AveReseda, CA 91335-3700 · (818) 774-3000

Phone(818) 774-3000

Organization SubpartNo

Authorized OfficialMary M ForrestChief Executive Officer · (818) 774-3208

Enumeration DateMay 24, 2005

Last NPPES UpdateJuly 22, 2016

✔ NPI 1417950163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in CA · 920000013

Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

7150 TAMPA AVE, Reseda, CA 91335

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Other Names 1

Other NameGrancell Village

Other Identifiers 3

Medicare NSC0592400001CA

MedicaidZZT05900FCA

Medicare ID-Type Unspecified555137CA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0694228

Grancell Village Of The Los Angeles Jewish Home · Reseda, CA

Active · expires Aug 31, 2026

CLIA Number05D0694228

Laboratory TypeHospital Dpsnf/Snf

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorNoachim Marco

Laboratory Phone(818) 774-3000

Laboratory LocationGrancell Village Of The Los Angeles Jewish Home7150 Tampa Ave, Reseda, CA 91335

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADREAN KENTRAY KNIGHT FNP

Nurse Practitioner