Basic Information
| Provider Information | |||||||||
| NPI: | 1598756710 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARADISE VALLEY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919502026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194704321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919502026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194704321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOLL | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6194704110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 0090000086 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT30024F | 05 | CA | MEDICAID | HSC30024F | 05 | CA | MEDICAID | HSM30024F | 05 | CA | MEDICAID | ZZT40024F | 05 | CA | MEDICAID |