Provider Demographics
NPI:1598703647
Name:NEIGHBORHOOD HEALTHCARE
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE
Other - Org Name:NEIGHBORHOOD HEALTHCARE - ESCONDIDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:REAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-737-2030
Mailing Address - Street 1:425 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3413
Mailing Address - Country:US
Mailing Address - Phone:760-737-2017
Mailing Address - Fax:760-520-8318
Practice Address - Street 1:460 N ELM ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3002
Practice Address - Country:US
Practice Address - Phone:760-520-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP70481FMedicaid
CAEAP70481FMedicaid
CAFHC70481FMedicaid
CAHAP70481FMedicaid
CA551866Medicare Oscar/Certification
CAW14158Medicare PIN
CA551867Medicare Oscar/Certification
CAFHC70481FMedicaid