Provider Demographics
NPI:1417965559
Name:PRIME HEALTHCARE LA PALMA, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE LA PALMA, LLC
Other - Org Name:LA PALMA INTERCOMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:3300 E. GUASTI ROAD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8654
Mailing Address - Country:US
Mailing Address - Phone:909-235-4400
Mailing Address - Fax:909-235-4316
Practice Address - Street 1:7901 WALKER STREET
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1722
Practice Address - Country:US
Practice Address - Phone:714-670-7400
Practice Address - Fax:714-229-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CA060000136282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05S580Medicare Oscar/Certification
05S580Medicare Oscar/Certification
CA050580Medicare Oscar/Certification
CA05S580Medicare Oscar/Certification