Provider Demographics
NPI:1174516975
Name:TRI CITY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TRI CITY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-940-5800
Mailing Address - Street 1:2095 W VISTA WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6029
Mailing Address - Country:US
Mailing Address - Phone:760-940-5801
Mailing Address - Fax:760-940-5880
Practice Address - Street 1:2095 W VISTA WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6029
Practice Address - Country:US
Practice Address - Phone:760-940-5801
Practice Address - Fax:760-940-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01727FOtherMEDICAID PROVIDER NUMBER