1992880512 NPI number — THC - ORANGE COUNTY LLC

Table of content: (NPI 1992880512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992880512 NPI number — THC - ORANGE COUNTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THC - ORANGE COUNTY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
D/B/A KINDRED HOSPITAL - SAN DIEGO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992880512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1940 EL CAJON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92104-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-4500
Provider Business Mailing Address Fax Number:
619-294-2979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-4500
Provider Business Practice Location Address Fax Number:
619-294-2979
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official Telephone Number:
629-253-5121

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  090000059 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZT40220I . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30220I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 052035 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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