Provider Demographics
NPI:1922033547
Name:CHA HOLLYWOOD MEDICAL CENTER, LP
Entity Type:Organization
Organization Name:CHA HOLLYWOOD MEDICAL CENTER, LP
Other - Org Name:HOLLYWOOD PRESBYTERIAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-913-4914
Mailing Address - Street 1:1300 NORTH VERMONT AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:213-413-3000
Mailing Address - Fax:323-660-7952
Practice Address - Street 1:1300 NORTH VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:213-413-3000
Practice Address - Fax:323-660-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CA930000067282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSD30063FMedicaid
CAZZT30063HMedicaid
CAHSC30063HMedicaid
ZZZA1914AOtherBLUE SHIELD PROVIDER #
CAZZT40063HMedicaid
CAZZT40063HMedicaid