Provider Demographics
NPI:1043395742
Name:THC - ORANGE COUNTY, LLC
Entity Type:Organization
Organization Name:THC - ORANGE COUNTY, LLC
Other - Org Name:KINDRED HOSPITAL - ONTARIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:550 N MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3318
Mailing Address - Country:US
Mailing Address - Phone:909-391-0333
Mailing Address - Fax:909-391-2892
Practice Address - Street 1:550 N MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-391-0333
Practice Address - Fax:909-391-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000561282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30041KMedicaid
CAZZZ94036ZOtherBLUE CROSS
CAHSP30041KMedicaid
CA=========OtherCIGNA
CA=========OtherSECURE HORIZONS
CA=========OtherPACIFICARE
CA=========OtherHUMANA
CA=========OtherTRICARE/CHAMPUS
CA=========OtherUNITED HEALTHCARE
CAHSP30041KMedicaid