Basic Information
| Provider Information | |||||||||
| NPI: | 1629242201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME HEALTHCARE SERVICES ENCINO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16237 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189955000 | ||||||||
| FaxNumber: | 8189078630 | ||||||||
| Practice Location | |||||||||
| Address1: | 16237 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189955000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHELL | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY & GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9092354311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 930000051 | CA | Y | Hospital Units | Psychiatric Unit |
No ID Information.