Provider Demographics
NPI:1093087157
Name:PRIME HEALTHCARE SERVICES ROXBOROUGH LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES ROXBOROUGH LLC
Other - Org Name:ROXBOROUGH MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4400
Mailing Address - Fax:909-235-4419
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-483-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
39S304Medicare Oscar/Certification