Healthcare Provider Details

I. General information

NPI: 1700973963
Provider Name (Legal Business Name): COUNTRY HILLS HEALTH CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 BROADWAY
EL CAJON CA
92021-5124
US

IV. Provider business mailing address

1580 BROADWAY
EL CAJON CA
92021-5124
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-8745
  • Fax: 619-334-3248
Mailing address:
  • Phone: 619-441-8745
  • Fax: 619-334-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number08000361
License Number StateCA

VIII. Authorized Official

Name: MISS CAROL J PATTEN
Title or Position: ACCOUNTS RECEIVABLE SUPERVISOR
Credential:
Phone: 619-441-8745