Provider Demographics
NPI:1326135823
Name:MORENO VALLEY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:MORENO VALLEY COMMUNITY HOSPITAL
Other - Org Name:VALLEY HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARKO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:951-766-6472
Mailing Address - Street 1:1117 E DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-652-2811
Mailing Address - Fax:951-925-6323
Practice Address - Street 1:27300 IRIS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-652-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30694FMedicaid
CAHSP40694FMedicaid
CAZZZC3305ZOtherBLUE SHIELD
CAHSM30694FMedicaid
CAHSP40694FMedicaid