Basic Information
| Provider Information | |||||||||
| NPI: | 1386947836 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIME HEALTHCARE LA PALMA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LA PALMA INTERCOMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 WALKER ST | ||||||||
| Address2: | |||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906231722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146707400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7901 WALKER ST | ||||||||
| Address2: | |||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906231722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146707400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2010 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHELL | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY / GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9092354311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.