Provider Demographics
NPI:1114547114
Name:PRIME HEALTHCARE SERVICES - ST FRANCIS LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - ST FRANCIS LLC
Other - Org Name:ST FRANCIS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-4706
Mailing Address - Street 1:3480 E GUASTI RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7684
Mailing Address - Country:US
Mailing Address - Phone:909-235-4400
Mailing Address - Fax:
Practice Address - Street 1:3630 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2609
Practice Address - Country:US
Practice Address - Phone:310-900-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55238GMedicaid
CAHSC30104GMedicaid
CAZZT40104GMedicaid
CAZZT30104GMedicaid
CAHSM30104GMedicaid