Provider Demographics
NPI:1972619104
Name:ST. PAUL'S EPISCOPAL HOME, INC.
Entity Type:Organization
Organization Name:ST. PAUL'S EPISCOPAL HOME, INC.
Other - Org Name:ST. PAUL'S HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-239-6900
Mailing Address - Street 1:328 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6522
Mailing Address - Country:US
Mailing Address - Phone:619-239-6900
Mailing Address - Fax:619-239-1256
Practice Address - Street 1:235 NUTMEG ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6201
Practice Address - Country:US
Practice Address - Phone:619-239-8687
Practice Address - Fax:619-239-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55144FMedicaid
CA555144Medicare Oscar/Certification