Provider Demographics
NPI:1013024223
Name:HYGEIA LTC CORP.
Entity Type:Organization
Organization Name:HYGEIA LTC CORP.
Other - Org Name:HYGEIA LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HASBUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-263-4903
Mailing Address - Street 1:786 MONTEREY PASS RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-3607
Mailing Address - Country:US
Mailing Address - Phone:323-263-4939
Mailing Address - Fax:
Practice Address - Street 1:786 MONTEREY PASS RD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-3607
Practice Address - Country:US
Practice Address - Phone:323-263-4939
Practice Address - Fax:323-263-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY482173336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5623409OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CA1013024223Medicaid
CA5946910001Medicare NSC