1093750747 NPI number — INTERIM HEALTHCARE SAN DIEGO LLC

Table of content: (NPI 1093750747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093750747 NPI number — INTERIM HEALTHCARE SAN DIEGO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE SAN DIEGO 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:
INTERIM HEALTHCARE SAN DIEGO HOME HEALTH
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:
1093750747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 W 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-4843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-432-9811
Provider Business Mailing Address Fax Number:
760-739-1366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-432-9811
Provider Business Practice Location Address Fax Number:
760-739-1366
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGILLAN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
GENERAL COUNSEL CHIEF COMPLIANCE OF
Authorized Official Telephone Number:
301-956-5087

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  080000395 , 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: HHA57418F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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