Healthcare Provider Details

I. General information

NPI: 1205166782
Provider Name (Legal Business Name): EDGMOOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 PARK CENTER DR
SANTEE CA
92071-6957
US

IV. Provider business mailing address

4423 44TH ST APT C
SAN DIEGO CA
92115-4343
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number243843
License Number StateCA

VIII. Authorized Official

Name: MS. JENNIFER WANJIRU NJERU
Title or Position: LVN
Credential:
Phone: 619-795-1570