Basic Information
| Provider Information | |||||||||
| NPI: | 1013196807 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIME HEALTHCARE CENTINELA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTINELA HOSPITAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12479 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917102670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094648847 | ||||||||
| FaxNumber: | 9094648887 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N PRAIRIE AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903014501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106801488 | ||||||||
| FaxNumber: | 3106770535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | SARRAO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT & GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9094648847 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | CA | Y | Hospital Units | Rehabilitation Unit |
No ID Information.