Healthcare Provider Details

I. General information

NPI: 1780655670
Provider Name (Legal Business Name): HOSPITAL OF BARSTOW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3004
US

IV. Provider business mailing address

PO BOX 844809
DALLAS TX
75284-4809
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-1761
  • Fax: 760-957-3048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number240000110
License Number StateCA

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OPERATIONS/AO
Credential:
Phone: 615-221-3840