Provider Demographics
NPI:1003012360
Name:AMI/HTI TARZANA ENCINO JOINT VENTURE
Entity Type:Organization
Organization Name:AMI/HTI TARZANA ENCINO JOINT VENTURE
Other - Org Name:ENCINO-TARZANA REGIONAL MEDICAL CTR-ENCINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2466
Mailing Address - Street 1:PO BOX 50585
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:818-907-8630
Practice Address - Street 1:16237 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2201
Practice Address - Country:US
Practice Address - Phone:818-881-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMI/HTI TARZANA ENCINO JOINT VENTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-25
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000051314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
55-5380Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER