Provider Demographics
NPI:1922001809
Name:ALTA LOS ANGELES HOSPITALS, INC.
Entity Type:Organization
Organization Name:ALTA LOS ANGELES HOSPITALS, INC.
Other - Org Name:LOS ANGELES COMM HOSP, NORWALK COMM HOSP & LA COMM HOSP AT BELLFLOWER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:4081 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-3330
Mailing Address - Country:US
Mailing Address - Phone:323-267-0477
Mailing Address - Fax:323-261-0809
Practice Address - Street 1:4081 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3330
Practice Address - Country:US
Practice Address - Phone:323-267-0477
Practice Address - Fax:323-261-0809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA HOSPITALS SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000039273R00000X, 282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZD1917ZOtherBLUE SHEILD
CAHSP30663FMedicaid
CAHSP40663FMedicaid
CAHSC30663FMedicaid
CAZZZC8919ZOtherBLUE SHIELD
CALTC70086FMedicaid
CAZZZC8919ZOtherBLUE SHIELD
CAHSP40663FMedicaid