Provider Demographics
NPI:1184607418
Name:SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
Entity type:Organization
Organization Name:SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-522-3700
Mailing Address - Street 1:8695 SPECTRUM CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1489
Mailing Address - Country:US
Mailing Address - Phone:858-499-3027
Mailing Address - Fax:858-499-3020
Practice Address - Street 1:233 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1967
Practice Address - Country:US
Practice Address - Phone:619-522-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000036314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70017FMedicaid
CA0381360001Medicare NSC
CA055074Medicare Oscar/Certification