Provider Demographics
NPI:1114339918
Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Other - Org Name:OJAI VALLEY COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-652-5036
Mailing Address - Street 1:1306 MARICOPA HWY
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3131
Mailing Address - Country:US
Mailing Address - Phone:805-646-1401
Mailing Address - Fax:
Practice Address - Street 1:1306 MARICOPA HWY
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3131
Practice Address - Country:US
Practice Address - Phone:805-646-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05Z334OtherSWING BED CERTIFICATION NUMBER
CA05Z334Medicare Oscar/Certification
CA05Z334OtherSWING BED CERTIFICATION NUMBER