Organization
EDGEMOOR HOSPITAL/DPSNF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENMARIE HILLEARY (ADMINISTRATOR)
(619) 596-5500
Entity
Organization
Contact information
Practice address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-5500
(619) 596-5501
Mailing address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-5500
(619) 596-5501
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
090000092
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05008F
—
CA
Enumeration date
09/12/2007
Last updated
12/29/2009
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