Healthcare Provider Details

I. General information

NPI: 1659043834
Provider Name (Legal Business Name): FALLBROOK HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S MISSION RD
FALLBROOK CA
92028-2869
US

IV. Provider business mailing address

PO BOX 2155
FALLBROOK CA
92088-2155
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-7570
  • Fax:
Mailing address:
  • Phone: 760-723-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA SARGENT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-723-7570