Provider Demographics
NPI:1194016923
Name:CPH HOSPITAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:CPH HOSPITAL MANAGEMENT LLC
Other - Org Name:COAST PLAZA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-356-0550
Mailing Address - Street 1:222 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 950
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5648
Mailing Address - Country:US
Mailing Address - Phone:310-356-0550
Mailing Address - Fax:
Practice Address - Street 1:13100 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2531
Practice Address - Country:US
Practice Address - Phone:562-868-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194016923Medicaid
CA1194016923Medicaid