Basic Information
| Provider Information | |||||||||
| NPI: | 1366419517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTELOPE VALLEY HEALTH CARE DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495000 | ||||||||
| FaxNumber: | 6619495774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495000 | ||||||||
| FaxNumber: | 6619495774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | HONG | ||||||||
| AuthorizedOfficialFirstName: | KRISTINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD OF DIRECTORS- CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 6619495512 | ||||||||
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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 | 282N00000X | 930000008 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSM60056F | 05 | CA | MEDICAID | ZZT30056F | 05 | CA | MEDICAID | HSC30056F | 05 | CA | MEDICAID | ZZT40056F | 05 | CA | MEDICAID |