Provider Demographics
NPI:1508859323
Name:PIH HEALTH GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:PIH HEALTH GOOD SAMARITAN HOSPITAL
Other - Org Name:GOOD SAMARITAN HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE (SUE)
Authorized Official - Middle Name:R
Authorized Official - Last Name:PONCE (AKA CARLSON)
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-698-0811
Mailing Address - Street 1:1225 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1901
Mailing Address - Country:US
Mailing Address - Phone:213-977-2121
Mailing Address - Fax:213-202-7118
Practice Address - Street 1:1225 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1901
Practice Address - Country:US
Practice Address - Phone:213-977-2121
Practice Address - Fax:213-202-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000071282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30471FMedicaid
CAHSC30471FMedicaid