Healthcare Provider Details

I. General information

NPI: 1760709687
Provider Name (Legal Business Name): AETAS HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 PALM ST
LEMON GROVE CA
91945-2956
US

IV. Provider business mailing address

7922 PALM ST
LEMON GROVE CA
91945-2956
US

V. Phone/Fax

Practice location:
  • Phone: 619-644-1000
  • Fax: 619-644-1084
Mailing address:
  • Phone: 619-644-1000
  • Fax: 619-644-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090000142
License Number StateCA

VIII. Authorized Official

Name: TALAMADGE GALD CLINE
Title or Position: ADMINISTRATOR
Credential:
Phone: 619-644-1000