Provider Demographics
NPI:1700817756
Name:PLACENTIA LINDA HOSPITAL, INC.
Entity Type:Organization
Organization Name:PLACENTIA LINDA HOSPITAL, INC.
Other - Org Name:PLACENTIA LINDA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAWECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-524-4874
Mailing Address - Street 1:FILE 57507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:714-961-8427
Practice Address - Street 1:1301 N ROSE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3802
Practice Address - Country:US
Practice Address - Phone:714-993-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000157282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
8276OtherHEALTH NET
001295-0001OtherPACIFICARE OF CALIFORNIA
ZZZD3009ZOtherBS OF CALIFORNIA
000431OtherHUMANA
050589B000000OtherSECTION 1011
CAHSP40589IMedicaid
908905630OtherAETNA US HEALTHCARE (NATI
CAHSC30589IMedicaid
ZZZD3009ZOtherBS OF CALIFORNIA
=========928700000OtherTRICARE