Provider Demographics
NPI:1487647145
Name:TRI CITY HOSPITAL
Entity Type:Organization
Organization Name:TRI CITY HOSPITAL
Other - Org Name:TRI CITY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-940-5893
Mailing Address - Street 1:2095 W VISTA WAY
Mailing Address - Street 2:#220
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2095 W VISTA WAY
Practice Address - Street 2:#220
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6027
Practice Address - Country:US
Practice Address - Phone:760-940-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07503FMedicaid
CAHHA07503FMedicaid