Provider Demographics
NPI:1093750747
Name:INTERIM HEALTHCARE SAN DIEGO LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SAN DIEGO LLC
Other - Org Name:INTERIM HEALTHCARE SAN DIEGO HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL CHIEF COMPLIANCE OF
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MCGILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-956-5087
Mailing Address - Street 1:425 W 5TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4843
Mailing Address - Country:US
Mailing Address - Phone:760-432-9811
Mailing Address - Fax:760-739-1366
Practice Address - Street 1:425 W 5TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4843
Practice Address - Country:US
Practice Address - Phone:760-432-9811
Practice Address - Fax:760-739-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000395251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57418FMedicaid
CA557418Medicare Oscar/Certification