Healthcare Provider Details

I. General information

NPI: 1447409081
Provider Name (Legal Business Name): GROSSMONT HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5788 LYDEN WAY
SAN DIEGO CA
92120-4544
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-2503
  • Fax:
Mailing address:
  • Phone: 858-499-3025
  • Fax: 858-499-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number080000656
License Number StateCA

VIII. Authorized Official

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