Provider Demographics
NPI:1639236128
Name:EL CAMINO HOSPITAL-SNF
Entity Type:Organization
Organization Name:EL CAMINO HOSPITAL-SNF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-940-7368
Mailing Address - Street 1:2500 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4302
Mailing Address - Country:US
Mailing Address - Phone:650-940-7000
Mailing Address - Fax:
Practice Address - Street 1:2500 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4302
Practice Address - Country:US
Practice Address - Phone:650-940-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70100FMedicaid
CALTC55593FMedicaid
CALTC70100FMedicaid