Provider Demographics
NPI:1528055787
Name:POINT LOMA CONVALESCENT HOSPITAL
Entity type:Organization
Organization Name:POINT LOMA CONVALESCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-224-4141
Mailing Address - Street 1:3202 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5401
Mailing Address - Country:US
Mailing Address - Phone:619-224-4141
Mailing Address - Fax:619-224-1328
Practice Address - Street 1:3202 DUKE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5401
Practice Address - Country:US
Practice Address - Phone:619-224-4141
Practice Address - Fax:619-224-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
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
CAZZTO5322HMedicaid
CA4365879-8OtherSTATE TAX I.D.
CA05-5322Medicare ID - Type Unspecified
CAZZTO5322HMedicaid