Organization
KOA HOLDINGS, LLC
Active
Other names
COTTONWOOD CANYON HEALTHCARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MITCHELL (SECRETARY)
(385) 988-3319
Entity
Organization
Contact information
Practice address
1391 E MADISON AVE, EL CAJON, CA 92021-8568
(619) 444-1107
Mailing address
262 N UNIVERSITY AVE, FARMINGTON, UT 84025-2975
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
090000071
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05064I
—
CA
Enumeration date
06/20/2006
Last updated
08/20/2024
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