Basic Information
| Provider Information | |||||||||
| NPI: | 1225120710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANAHEIM GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3350 WEST BALL ROAD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149475800 | ||||||||
| FaxNumber: | 9497324671 | ||||||||
| Practice Location | |||||||||
| Address1: | 3350 WEST BALL ROAD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149475800 | ||||||||
| FaxNumber: | 9497324671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | BLOM | ||||||||
| AuthorizedOfficialFirstName: | CLARA | ||||||||
| AuthorizedOfficialMiddleName: | RUTH | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/HOSPITAL CFO | ||||||||
| AuthorizedOfficialTelephone: | 3104638273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC70119F | 05 | CA | MEDICAID | LTC55756 | 05 | CA | MEDICAID |