Provider Demographics
NPI:1417957473
Name:ELADH, LP
Entity Type:Organization
Organization Name:ELADH, LP
Other - Org Name:EAST LOS ANGELES DOCTORS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-356-0550
Mailing Address - Street 1:222 N SEPULVEDA BLVD
Mailing Address - Street 2:STE. 950
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5648
Mailing Address - Country:US
Mailing Address - Phone:310-356-0550
Mailing Address - Fax:
Practice Address - Street 1:4060 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2526
Practice Address - Country:US
Practice Address - Phone:323-268-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000049282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40641GMedicaid
CAPHB463650Medicaid
CAHSC30641GMedicaid
CAZZT30641GMedicaid
CAPHB463650Medicaid