Provider Demographics
NPI:1750491247
Name:PRIME HEALTHCARE SERVICES - SHERMAN OAKS, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - SHERMAN OAKS, LLC
Other - Org Name:SHERMAN OAKS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC, FCCP
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4400
Mailing Address - Fax:909-235-4419
Practice Address - Street 1:4929 VAN NUYS BLVD.
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1702
Practice Address - Country:US
Practice Address - Phone:818-981-7111
Practice Address - Fax:818-501-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000149282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP301141Medicaid
CAHSP30114IMedicaid
CAHSP401141Medicaid
CAZZZA1966ZOtherBLUE SHIELD
CAHSC30114IMedicaid
CAHSC301141Medicaid
CAHSP40114IMedicaid
CAZZZA1966ZOtherBLUE SHIELD