Basic Information
| Provider Information | |||||||||
| NPI: | 1740447945 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIME HEALTHCARE SERVICES - SAN DIMAS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAN DIMAS COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 EAST GUASTI ROAD, 3RD FLOOR | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917108655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092354327 | ||||||||
| FaxNumber: | 9092354316 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 W COVINA BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917733245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095996811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 06/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | DOAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 9092354307 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.