Provider Demographics
NPI:1700973963
Name:COUNTRY HILLS HEALTH CARE INCORPORATED
Entity Type:Organization
Organization Name:COUNTRY HILLS HEALTH CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-441-8745
Mailing Address - Street 1:1580 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5124
Mailing Address - Country:US
Mailing Address - Phone:619-441-8745
Mailing Address - Fax:619-334-3248
Practice Address - Street 1:1580 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5124
Practice Address - Country:US
Practice Address - Phone:619-441-8745
Practice Address - Fax:619-334-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08000361314000000X
CA332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMCSUB0TCOtherMEDICAL INTERNET USER ID
CALTC55431GMedicaid
CA555431Medicare PIN
CACMCSUB0TCOtherMEDICAL INTERNET USER ID
CA0834430001Medicare NSC