Provider Demographics
NPI:1689646820
Name:FALLBROOK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FALLBROOK HOSPITAL DISTRICT
Other - Org Name:FALLBROOK HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:624 E ELDER ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3004
Mailing Address - Country:US
Mailing Address - Phone:760-728-1191
Mailing Address - Fax:760-728-1875
Practice Address - Street 1:624 E ELDER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3004
Practice Address - Country:US
Practice Address - Phone:760-728-1191
Practice Address - Fax:760-728-0683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLBROOK HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055298Medicare Oscar/Certification