Basic Information
| Provider Information | |||||||||
| NPI: | 1770543761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE HOSPITAL OF EAST LOS ANGELES LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO ROAD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| Practice Location | |||||||||
| Address1: | 16453 SOUTH COLORADO AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625313110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOPWOOD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
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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 | 282E00000X | 930000088 | CA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSC30713F | 05 | CA | MEDICAID | HSC30571J | 05 | CA | MEDICAID | HSP30571J | 05 | CA | MEDICAID | HSP30713F | 05 | CA | MEDICAID |