Provider Demographics
NPI:1376598318
Name:SADDLEBACK MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SADDLEBACK MEMORIAL MEDICAL CENTER
Other - Org Name:SADDLEBACK COORDINATED HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-377-3218
Mailing Address - Street 1:24451 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3689
Mailing Address - Country:US
Mailing Address - Phone:949-837-4500
Mailing Address - Fax:949-452-3460
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-460-1500
Practice Address - Fax:949-460-1522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SADDLEBACK MEMORIAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000218251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07072IMedicaid
CAHHA07072IMedicaid