Basic Information
| Provider Information | |||||||||
| NPI: | 1750554721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUANTUM HEALTH | ||||||||
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| OtherOrganizationName: | PROMISE HOSPITAL OF SAN DIEGO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO ROAD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| Practice Location | |||||||||
| Address1: | 5550 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921052307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195823516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 12/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARMSTRONG | ||||||||
| AuthorizedOfficialFirstName: | DAVID J | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP/GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROMISE HOSPITAL OF SAN DIEGO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 090000105 | CA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSC30447I | 05 | CA | MEDICAID |