Basic Information
| Provider Information | |||||||||
| NPI: | 1285028951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MESA HILLS SPECIALTY HOSPITAL OPERATOR LLC | ||||||||
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| OtherOrganizationName: | MESA HILLS SPECIALTY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CLIFTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143963462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2311 N OREGON ST | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155323941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2015 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | NEUMAN | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2143963462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | TX | N | Hospitals | Long Term Care Hospital | 261QA1903X | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 283X00000X | TX | Y | Hospitals | Rehabilitation Hospital |
ID Information
| ID | Type | State | Issuer | Description | 353570001 | 05 | TX | MEDICAID |