Provider Demographics
NPI:1396824215
Name:COSTA MESA HEALTHCARE INC.
Entity Type:Organization
Organization Name:COSTA MESA HEALTHCARE INC.
Other - Org Name:NEWPORT SUBACUTE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUSTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-0509
Mailing Address - Street 1:2570 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1331
Mailing Address - Country:US
Mailing Address - Phone:949-631-4282
Mailing Address - Fax:949-631-8681
Practice Address - Street 1:2570 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1331
Practice Address - Country:US
Practice Address - Phone:949-631-4282
Practice Address - Fax:949-631-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC55751G314000000X
CALTC70146G314000000X
CA555751314000000X
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55751GMedicaid
CALTC70146GMedicaid
CA555751Medicare Oscar/Certification