Basic Information
| Provider Information | |||||||||
| NPI: | 1750365375 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEANCO HEALTHCARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MISSION COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14850 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187872222 | ||||||||
| FaxNumber: | 8183048646 | ||||||||
| Practice Location | |||||||||
| Address1: | 14850 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187872222 | ||||||||
| FaxNumber: | 8183048646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THEIRING | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8189043685 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000101 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.