Provider Demographics
NPI:1063482412
Name:PALOMAR HEALTH
Entity Type:Organization
Organization Name:PALOMAR HEALTH
Other - Org Name:PALOMAR HEALTH CENTER FOR BEHAVIORAL HEALTH - PMC ESCONDIDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-740-6385
Mailing Address - Street 1:2125 CITRACADO PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3048
Practice Address - Country:US
Practice Address - Phone:858-675-5259
Practice Address - Fax:858-675-5181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALOMAR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000083273R00000X
273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM30115FMedicaid
CA05S115Medicare Oscar/Certification