Provider Demographics
NPI:1679879589
Name:VICTOR VALLEY HOSPITAL ACQUISITION, INC.
Entity Type:Organization
Organization Name:VICTOR VALLEY HOSPITAL ACQUISITION, INC.
Other - Org Name:VICTOR VALLEY GLOBAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-987-8100
Mailing Address - Street 1:15248 11TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3704
Mailing Address - Country:US
Mailing Address - Phone:760-843-6105
Mailing Address - Fax:760-843-6021
Practice Address - Street 1:15248 11TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3704
Practice Address - Country:US
Practice Address - Phone:760-843-6105
Practice Address - Fax:760-843-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000218282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30517FMedicaid
CA050517Medicare Oscar/Certification
CA05-0517Medicare PIN