Provider Demographics
NPI:1073902672
Name:POMERADO OPERATIONS, LLC
Entity Type:Organization
Organization Name:POMERADO OPERATIONS, LLC
Other - Org Name:BOULDER CREEK POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LELEAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-220-2000
Mailing Address - Street 1:114 PACIFICA
Mailing Address - Street 2:SUITE 230
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:858-487-6242
Mailing Address - Fax:858-487-4282
Practice Address - Street 1:12696 MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2500
Practice Address - Country:US
Practice Address - Phone:858-487-6242
Practice Address - Fax:858-487-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555206Medicare Oscar/Certification