Provider Demographics
NPI:1841592979
Name:INTERIM HEALTHCARE SAN DIEGO LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SAN DIEGO LLC
Other - Org Name:INTERIM HEALTHCARE SAN DIEGO HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL AND CHIEF COMPLIANC
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MCGILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-956-5087
Mailing Address - Street 1:1551 SAWGRS CORP PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2832
Mailing Address - Country:US
Mailing Address - Phone:301-956-5087
Mailing Address - Fax:858-737-7481
Practice Address - Street 1:5625 RUFFIN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-6392
Practice Address - Country:US
Practice Address - Phone:954-858-2871
Practice Address - Fax:858-737-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551612Medicare Oscar/Certification