# COUNTRY HILLS HEALTH CARE INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700973963
- **Authorized official:** MISS CAROL J PATTEN (ACCOUNTS RECEIVABLE SUPERVISOR)
- **Authorized official phone:** (619) 441-8745

## Contact information

- **Practice address:** 1580 BROADWAY, EL CAJON, CA 92021-5124
- **Practice address phone:** (619) 441-8745
- **Practice address fax:** (619) 334-3248
- **Mailing address:** 1580 BROADWAY, EL CAJON, CA 92021-5124
- **Mailing address phone:** (619) 441-8745
- **Mailing address fax:** (619) 334-3248

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 08000361 | CA | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | — | CA | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | CA | — |

## Other

- **Enumeration date:** 10/09/2006
- **Last updated:** 12/20/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CMCSUB0TC | MEDICAL INTERNET USER ID | CA |
| 05 | — | LTC55431G | — | CA |