Provider Demographics
NPI:1811220270
Name:QUINCE HOLDINGS, LLC
Entity Type:Organization
Organization Name:QUINCE HOLDINGS, LLC
Other - Org Name:PUEBLO SPRINGS REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:100 E SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2986
Mailing Address - Country:US
Mailing Address - Phone:760-471-0388
Mailing Address - Fax:760-471-0311
Practice Address - Street 1:5545 E LEE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4205
Practice Address - Country:US
Practice Address - Phone:520-296-2306
Practice Address - Fax:520-296-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486014Medicaid
AZ486014Medicaid