Provider Demographics
NPI:1891737078
Name:INTERIM HEALTHCARE SAN DIEGO LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SAN DIEGO LLC
Other - Org Name:INTERIM HEALTHCARE SAN DIEGO HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL CHIEF COMPLIANCE OF
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-956-5087
Mailing Address - Street 1:1551 SAWGRASS CORPORATE 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:800-338-7786
Mailing Address - Fax:
Practice Address - Street 1:5625 RUFFIN RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1395
Practice Address - Country:US
Practice Address - Phone:858-576-9501
Practice Address - Fax:858-576-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000335251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07807FMedicaid
CAHHA07807FMedicaid