Provider Demographics
NPI:1437322377
Name:PRIME HEALTHCARE SERVICES ENCINO LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES ENCINO LLC
Other - Org Name:ENCINO HOSPITAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4311
Mailing Address - Street 1:16237 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2201
Mailing Address - Country:US
Mailing Address - Phone:818-995-5000
Mailing Address - Fax:818-907-8630
Practice Address - Street 1:16237 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2201
Practice Address - Country:US
Practice Address - Phone:818-881-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000051282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050158Medicare Oscar/Certification