Provider Demographics
NPI:1578529285
Name:VALLEY PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:VALLEY PRESBYTERIAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PFS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYMICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-902-2919
Mailing Address - Street 1:15107 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4542
Mailing Address - Country:US
Mailing Address - Phone:818-902-2919
Mailing Address - Fax:818-902-5797
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-902-2919
Practice Address - Fax:818-902-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000170273Y00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30126FMedicaid
CAZZT40126FMedicaid
CAHSC30126FMedicaid
CAHSC30126FMedicaid
CAZZT40126FMedicaid