Provider Demographics
NPI:1033149083
Name:COMMUNITYHOSPITALOFLOSGATOS,INC.
Entity Type:Organization
Organization Name:COMMUNITYHOSPITALOFLOSGATOS,INC.
Other - Org Name:COMMUNITYHOSPITALOFLOSGATOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:FILE57434
Mailing Address - Street 2:
Mailing Address - City:LOSANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7434
Mailing Address - Country:US
Mailing Address - Phone:209-578-2513
Mailing Address - Fax:408-866-4003
Practice Address - Street 1:815 POLLARD RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1438
Practice Address - Country:US
Practice Address - Phone:408-378-6131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000025282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30188GMedicaid
ZZZA4305ZOtherBS OF CALIFORNIA
004313-0001OtherPACIFICARE OF CALIFORNIA
CAHSP30188GMedicaid
CAHSP40188GMedicaid
239406020OtherAETNA US HEALTHCARE (NATI
000425OtherHUMANA
050188B000000OtherSECTION 1011
000425OtherHUMANA