Provider Demographics
NPI:1326297078
Name:ST. JOSEPH HOSPITAL OF ORANGE
Entity Type:Organization
Organization Name:ST. JOSEPH HOSPITAL OF ORANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-771-8000
Mailing Address - Street 1:PO BOX 5600
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5600
Mailing Address - Country:US
Mailing Address - Phone:714-771-8238
Mailing Address - Fax:
Practice Address - Street 1:2212 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3811
Practice Address - Country:US
Practice Address - Phone:714-771-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH HOSPITAL OF ORANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30069FMedicaid
CAHSC30069FMedicaid