Provider Demographics
NPI:1205822988
Name:FALLBROOK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FALLBROOK HOSPITAL DISTRICT
Other - Org Name:FALLBROOK HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMORZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-728-1191
Mailing Address - Street 1:624 E ELDER ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3004
Mailing Address - Country:US
Mailing Address - Phone:760-728-1191
Mailing Address - Fax:760-728-1875
Practice Address - Street 1:624 E ELDER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3004
Practice Address - Country:US
Practice Address - Phone:760-728-1191
Practice Address - Fax:760-728-1875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLBROOK HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-27
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000426251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57001FMedicaid
CA557001Medicare Oscar/Certification