Healthcare Provider Details

I. General information

NPI: 1477244234
Provider Name (Legal Business Name): SKILLED HARTFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 HARTFIELD AVE
SAN DIEGO CA
92130-1511
US

IV. Provider business mailing address

1817 AVENIDA DEL DIABLO
ESCONDIDO CA
92029-3112
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-2222
  • Fax:
Mailing address:
  • Phone: 619-201-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KIRBY
Title or Position: MANAGER
Credential:
Phone: 619-201-5888