Provider Demographics
NPI:1568532133
Name:GARDENA PHYSICIANS HOSPITAL, INC.
Entity Type:Organization
Organization Name:GARDENA PHYSICIANS HOSPITAL, INC.
Other - Org Name:COMMUNITY HOSPITAL OF GARDENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-488-3188
Mailing Address - Street 1:1300 W 155TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4049
Mailing Address - Country:US
Mailing Address - Phone:714-488-3188
Mailing Address - Fax:
Practice Address - Street 1:1246 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4011
Practice Address - Country:US
Practice Address - Phone:310-768-2235
Practice Address - Fax:310-768-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40456HMedicaid
CAHSP30456HMedicaid
CA555525OtherMEDICARE SNF