Healthcare Provider Details

I. General information

NPI: 1417930249
Provider Name (Legal Business Name): GROSSMONT HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-6000
  • Fax:
Mailing address:
  • Phone: 858-499-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000006
License Number StateCA

VIII. Authorized Official

Name: SCOTT EVANS
Title or Position: CEO
Credential:
Phone: 619-740-4648