Provider Demographics
NPI:1104005990
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:SECRETARY / GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4311
Mailing Address - Street 1:555 E HARDY ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4011
Mailing Address - Country:US
Mailing Address - Phone:310-673-4660
Mailing Address - Fax:310-677-0535
Practice Address - Street 1:555 E HARDY ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4011
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:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit