1467449066 NPI number — FALLBROOK HOSPITAL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467449066 NPI number — FALLBROOK HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALLBROOK HOSPITAL DISTRICT
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:
FALLBROOK HOSPITAL HOSPICE
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:
1467449066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 E ELDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLBROOK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92028-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-728-1435
Provider Business Mailing Address Fax Number:
760-728-1875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 E ELDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLBROOK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92028-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-728-1435
Provider Business Practice Location Address Fax Number:
760-728-1875
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMORZEWSKI
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
760-728-1191

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  080000426 , 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: HPC01575F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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