Provider Demographics
NPI:1467449066
Name:FALLBROOK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FALLBROOK HOSPITAL DISTRICT
Other - Org Name:FALLBROOK HOSPITAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMORZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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:760-728-1435
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:760-728-1435
Practice Address - Fax:760-728-1875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLBROOK HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000426251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01575FMedicaid
CA051575Medicare Oscar/Certification