Provider Demographics
NPI:1518327733
Name:CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE
Entity Type:Organization
Organization Name:CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE
Other - Org Name:CASA COLINA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVERSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-596-7733
Mailing Address - Street 1:255 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1923
Mailing Address - Country:US
Mailing Address - Phone:909-596-7733
Mailing Address - Fax:909-593-0153
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-593-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000026283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05T782Medicare Oscar/Certification