Provider Demographics
NPI:1790712131
Name:AMI/HTI TARZANA ENCINO JOINT VENTURE
Entity Type:Organization
Organization Name:AMI/HTI TARZANA ENCINO JOINT VENTURE
Other - Org Name:ENCINO-TARZANA REGIONAL MEDICAL CTR-ENCINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2530
Mailing Address - Street 1:PO BOX 31001-0152
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1526
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:818-907-8630
Practice Address - Street 1:16237 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2201
Practice Address - Country:US
Practice Address - Phone:818-881-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000051282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZA1953ZOtherBS OF CALIFORNIA
050158B000000OtherSECTION 1011
CAHSC31408IMedicaid
CAHSP40158LMedicaid
CAHSP30158LMedicaid
ZZZA1953ZOtherBS OF CALIFORNIA