Provider Demographics
NPI:1861491490
Name:WEST ESCONDIDO HEALTHCARE LLC
Entity Type:Organization
Organization Name:WEST ESCONDIDO HEALTHCARE LLC
Other - Org Name:PALOMAR VISTA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:201 NORTH FIG STREET
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3416
Mailing Address - Country:US
Mailing Address - Phone:760-746-0303
Mailing Address - Fax:760-738-1749
Practice Address - Street 1:201 NORTH FIG STREET
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3416
Practice Address - Country:US
Practice Address - Phone:760-746-0303
Practice Address - Fax:760-738-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000042314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05067HMedicaid
CA055067Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
CAZZT05067HMedicaid