Basic Information
Provider Information
NPI: 1073797916
EntityType: 2
ReplacementNPI:  
OrganizationName: ARROWHEAD REGIONAL MEDICAL CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 400 N PEPPER AVE
Address2:  
City: COLTON
State: CA
PostalCode: 923241801
CountryCode: US
TelephoneNumber: 9095801000
FaxNumber: 9095802677
Practice Location
Address1: 400 N PEPPER AVE
Address2:  
City: COLTON
State: CA
PostalCode: 923241801
CountryCode: US
TelephoneNumber: 9095801000
FaxNumber: 9095802677
Other Information
ProviderEnumerationDate: 12/27/2007
LastUpdateDate: 12/27/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HALLER
AuthorizedOfficialFirstName: COLENE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF OPERATING OFFICER
AuthorizedOfficialTelephone: 9095806180
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X CAY HospitalsGeneral Acute Care Hospital 

ID Information
IDTypeStateIssuerDescription
HSD30245F05CA MEDICAID


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