Provider Demographics
NPI:1013196807
Name:PRIME HEALTHCARE CENTINELA LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE CENTINELA LLC
Other - Org Name:CENTINELA HOSPITAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT & GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SARRAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-8847
Mailing Address - Street 1:12479 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2670
Mailing Address - Country:US
Mailing Address - Phone:909-464-8847
Mailing Address - Fax:909-464-8887
Practice Address - Street 1:333 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4501
Practice Address - Country:US
Practice Address - Phone:310-680-1488
Practice Address - Fax:310-677-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit