Provider Demographics
NPI:1982870978
Name:ENTRA HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:ENTRA HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STROBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-458-2646
Mailing Address - Street 1:3111 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5732
Mailing Address - Country:US
Mailing Address - Phone:877-458-2646
Mailing Address - Fax:619-584-4504
Practice Address - Street 1:3111 CAMINO DEL RIO N
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5732
Practice Address - Country:US
Practice Address - Phone:877-458-2646
Practice Address - Fax:619-584-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6402330001Medicare NSC