Provider Demographics
NPI:1760487987
Name:PIH HEALTH WHITTIER HOSPITAL
Entity Type:Organization
Organization Name:PIH HEALTH WHITTIER HOSPITAL
Other - Org Name:PIH HEALTH HOSPITAL WHITTIER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPECIA LPROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PONCE (AKA CARLSON)
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-698-0811
Mailing Address - Street 1:15050 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1301
Mailing Address - Country:US
Mailing Address - Phone:562-902-7763
Mailing Address - Fax:562-944-6169
Practice Address - Street 1:15050 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1301
Practice Address - Country:US
Practice Address - Phone:562-902-7763
Practice Address - Fax:562-944-6169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIH HEALTH HOSPITAL WHITTIER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-15
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01542FMedicaid
CAHPC01542FMedicaid
CA051542Medicare Oscar/Certification