1811929359 NPI number — SAN DIMAS COMMUNITY HOSPITAL, INC.

Table of content: (NPI 1811929359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811929359 NPI number — SAN DIMAS COMMUNITY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN DIMAS COMMUNITY HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAN DIMAS COMMUNITY HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811929359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 57543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-300-4122
Provider Business Mailing Address Fax Number:
909-599-0629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 W COVINA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIMAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91773-3245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-599-6811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
310-775-8043

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  93000039 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95-3783605 . This is a "INTER VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783616 . This is a "WELLPOINT HEALTH NETWORKS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000410 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 578531560 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783606 . This is a "INTERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050588B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783611 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40588G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: X-0220213 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005316-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783614 . This is a "TENET EMPLOYEES BENEFIT P" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30588G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199470000 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8423 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783607 . This is a "KAISER FOUNDATION HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783608 . This is a "LOS ANGELES FOUNDATION FO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95-3783602 . This is a "BEECH STREET HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA2019Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com