Provider Demographics
NPI:1225172398
Name:REDLANDS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:REDLANDS COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-5501
Mailing Address - Street 1:350 TERRACINA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4850
Mailing Address - Country:US
Mailing Address - Phone:909-335-5501
Mailing Address - Fax:909-335-6494
Practice Address - Street 1:350 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4850
Practice Address - Country:US
Practice Address - Phone:909-335-5501
Practice Address - Fax:909-335-6494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDLANDS COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 314000000X
CA240000191282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01534FMedicaid
CA240000191OtherBUSINESS LICENSE