Provider Demographics
NPI:1629254545
Name:NEIGHBORHOOD HEALTHCARE
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE
Other - Org Name:
Other - Org Type:
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:760-520-8375
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:760-737-2035
Mailing Address - Fax:760-520-8314
Practice Address - Street 1:641 E PENNSYLVANIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3047
Practice Address - Country:US
Practice Address - Phone:760-520-8200
Practice Address - Fax:760-737-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70608FMedicaid
CAW14158Medicare PIN
CAFHC70608FMedicaid