Provider Demographics
NPI:1225015985
Name:VSC HBO, LLC
Entity Type:Organization
Organization Name:VSC HBO, LLC
Other - Org Name:HEALTHBRIDGE CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSOLVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-289-2400
Mailing Address - Street 1:393 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2501
Mailing Address - Country:US
Mailing Address - Phone:714-289-2400
Mailing Address - Fax:714-289-2367
Practice Address - Street 1:393 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2501
Practice Address - Country:US
Practice Address - Phone:714-289-2400
Practice Address - Fax:714-289-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
281PC2000X, 282E00000X, 282NC2000X, 283XC2000X
CA060000530284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No281PC2000XHospitalsChronic Disease HospitalChildren
No282E00000XHospitalsLong Term Care Hospital
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC3308FMedicaid
CALTC55753FMedicaid
CALTC40008FMedicaid
CAHST33308FMedicaid
CAHSP33308FMedicaid
CALTP40008FMedicaid
CA053308Medicare Oscar/Certification
CALTP40008FMedicaid