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DSH050115K PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido) (Terminated)
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Main Details
Name
PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)
Subdivision Name
Palomar Outpatient Behavioral Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050115K
Medicare Provider Number
050115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/21/2015
Last Recertification Date
9/4/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Palomar Health
Carlos A. Bohorquez, Chief FInancial Officer
(760) 740-6385
Primary Contact
Cedric Terrell, AVP Clinical & Diagnostic Services
(760) 739-3932
Addresses
Street Address
125 Vallecitos De Oro, Suite A
San Marcos, CA 92069
Billing Address
Palomar Health
2227 Enterprise St
San Marcos, CA 92029
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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