Basic Information
| Provider Information | |||||||||
| NPI: | 1639236128 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL CAMINO HOSPITAL-SNF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 GRANT RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940404302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 GRANT RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940404302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRIONES | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT CFO | ||||||||
| AuthorizedOfficialTelephone: | 6509407368 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | CA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | LTC70100F | 05 | CA | MEDICAID | LTC55593F | 05 | CA | MEDICAID |