Collingwood Manor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

090000120 Issued in CA

Legal business name

COLLINGWOOD MANOR LLC

Practice address

553 F Street
Chula Vista, CA 91910-3515

Phone

(619) 426-8611

Fax

(619) 426-2315

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary P Miller

Title

Chief Legal Counsel

Phone

(619) 441-8771

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Collingwood Manor Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1366518524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 F STREET",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919103515",
            "telephone_number": "619-426-8611",
            "fax_number": "619-426-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 F STREET",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919103515",
            "telephone_number": "619-426-8611",
            "fax_number": "619-426-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINGWOOD MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF LEGAL COUNSEL",
        "authorized_official_telephone_number": "619-441-8771",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "090000120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT 11310G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collingwood Manor",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Skilled Nursing Facility in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.