Provider Demographics
NPI:1821075870
Name:CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE
Entity Type:Organization
Organization Name:CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVERSO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:909-596-7733
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91769-6001
Mailing Address - Country:US
Mailing Address - Phone:909-596-7733
Mailing Address - Fax:909-593-1053
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-593-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000026283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC32019FMedicaid
CAZZT42019FOtherMEDICAL
CAZZT42019FOtherMEDICAL
CA053027Medicare Oscar/Certification