Provider Demographics
NPI:1164410593
Name:USC ARCADIA HOSPITAL
Entity Type:Organization
Organization Name:USC ARCADIA HOSPITAL
Other - Org Name:METHODIST HOSPITAL OF SOUTHERN CALIFORNIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MMEJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-574-3600
Mailing Address - Street 1:300 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3402
Mailing Address - Country:US
Mailing Address - Phone:626-898-8000
Mailing Address - Fax:626-898-8890
Practice Address - Street 1:300 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3402
Practice Address - Country:US
Practice Address - Phone:626-898-8000
Practice Address - Fax:626-898-8890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USC ARCADIA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-10
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000103273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05T238Medicare Oscar/Certification