Provider Demographics
NPI:1023010113
Name:SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
Other - Org Name:SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD, AT VAN NUYS, AT CULVER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-943-4500
Mailing Address - Street 1:3415 S SEPULVEDA BLVD FL 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6060
Mailing Address - Country:US
Mailing Address - Phone:310-943-4500
Mailing Address - Fax:310-943-4501
Practice Address - Street 1:6245 DE LONGPRE AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-8253
Practice Address - Country:US
Practice Address - Phone:323-462-2271
Practice Address - Fax:323-463-3830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA HOSPITALS SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-02
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000066282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30135IMedicaid
CAZZZC9928ZOtherBLUE SHEILD
CAHSP40135IMedicaid
CAHSC30135IMedicaid
CAHSC30135IMedicaid