Provider Demographics
NPI:1568578110
Name:RANCHO CUCAMONGA COMMUNITY HOSPITAL, LLC
Entity Type:Organization
Organization Name:RANCHO CUCAMONGA COMMUNITY HOSPITAL, LLC
Other - Org Name:RANCHO SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ISHII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-581-6400
Mailing Address - Street 1:10841 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3811
Mailing Address - Country:US
Mailing Address - Phone:909-581-6400
Mailing Address - Fax:909-581-6418
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3811
Practice Address - Country:US
Practice Address - Phone:909-581-6400
Practice Address - Fax:909-581-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
052049Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER