Provider Demographics
NPI:1225120710
Name:ANAHEIM GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ANAHEIM GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/HOSPITAL CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-463-8273
Mailing Address - Street 1:3350 WEST BALL ROAD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-947-5800
Mailing Address - Fax:949-732-4671
Practice Address - Street 1:3350 WEST BALL ROAD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-947-5800
Practice Address - Fax:949-732-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70119FMedicaid
CALTC55756Medicaid
CALTC70119FMedicaid