Provider Demographics
NPI:1407035512
Name:POPLAR HOLDINGS, LLC
Entity Type:Organization
Organization Name:POPLAR HOLDINGS, LLC
Other - Org Name:POWAY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:262 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2975
Mailing Address - Country:US
Mailing Address - Phone:801-447-9823
Mailing Address - Fax:
Practice Address - Street 1:15632 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2406
Practice Address - Country:US
Practice Address - Phone:858-485-5153
Practice Address - Fax:858-485-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407035512Medicaid
CALTC55136IMedicaid
CA555136Medicare Oscar/Certification