Provider Demographics
NPI:1780668434
Name:HENRY MAYO NEWHALL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY MAYO NEWHALL MEMORIAL HOSPITAL
Other - Org Name:HENRY MAYO NEWHALL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-200-1021
Mailing Address - Street 1:23845 MCBEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2001
Mailing Address - Country:US
Mailing Address - Phone:661-253-8000
Mailing Address - Fax:661-200-1033
Practice Address - Street 1:23845 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2001
Practice Address - Country:US
Practice Address - Phone:661-253-8000
Practice Address - Fax:661-200-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40624FMedicaid
CACGP006630Medicaid
CAZZT30624FMedicaid
CAZZZC9929ZOtherBLUE SHIELD PROVIDER #
CAC0688832OtherCHAMPUS PROVIDER #
CAHSC30624FMedicaid
CACGP165127Medicaid
CACGP165127Medicaid