Provider Demographics
NPI:1265468946
Name:ALVARADO HOSPITAL, LLC
Entity Type:Organization
Organization Name:ALVARADO HOSPITAL, LLC
Other - Org Name:ALVARADO HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4307
Mailing Address - Street 1:6655 ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5208
Mailing Address - Country:US
Mailing Address - Phone:619-229-3172
Mailing Address - Fax:619-229-3273
Practice Address - Street 1:6655 ALVARADO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5208
Practice Address - Country:US
Practice Address - Phone:619-229-3172
Practice Address - Fax:619-229-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000013282N00000X
CAHSP48400333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050757B000000OtherSECTION 1011
CAHSP30583IMedicaid
CAHSC30583IMedicaid
CAZZZA3726ZOtherTRICARE
CAZZZA3726ZOtherBLUE SHIELD
CAHSP40583IMedicaid
CAHSC30583IMedicaid