Basic Information
| Provider Information | |||||||||
| NPI: | 1700817756 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLACENTIA LINDA HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PLACENTIA LINDA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57507 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 7149618427 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 N ROSE DR | ||||||||
| Address2: | |||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928703802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149932000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | GAWECO | ||||||||
| AuthorizedOfficialFirstName: | ANGELIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7145244874 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 060000157 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 8276 | 01 | HEALTH NET | OTHER | 001295-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER | ZZZD3009Z | 01 | BS OF CALIFORNIA | OTHER | 000431 | 01 | HUMANA | OTHER | 050589B000000 | 01 | SECTION 1011 | OTHER | HSP40589I | 05 | CA | MEDICAID | 908905630 | 01 | AETNA US HEALTHCARE (NATI | OTHER | HSC30589I | 05 | CA | MEDICAID |