Healthcare Provider Details

I. General information

NPI: 1689995045
Provider Name (Legal Business Name): PREFERRED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 RUFFNER ST 270
SAN DIEGO CA
92111-2275
US

IV. Provider business mailing address

PO BOX 17860
SAN DIEGO CA
92177-7860
US

V. Phone/Fax

Practice location:
  • Phone: 180-078-7678
  • Fax: 800-787-6762
Mailing address:
  • Phone: 180-078-7678
  • Fax: 800-787-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6912
License Number StateCA

VIII. Authorized Official

Name: MS. MELANIE REITEN
Title or Position: PRESIDENT
Credential:
Phone: 18007876787