Provider Demographics
NPI:1922039205
Name:CHCM, INC.
Entity Type:Organization
Organization Name:CHCM, INC.
Other - Org Name:COSTA MESA MEDICAL CENTER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:949-574-3328
Mailing Address - Street 1:301 VICTORIA ST.
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1995
Mailing Address - Country:US
Mailing Address - Phone:949-574-3328
Mailing Address - Fax:949-574-3320
Practice Address - Street 1:301 VICTORIA ST.
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1995
Practice Address - Country:US
Practice Address - Phone:949-574-3328
Practice Address - Fax:949-574-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06 0000 100282N00000X
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30543KMedicaid
CAHSP40543KMedicaid
CAHSM30543KMedicaid
CA050543Medicare ID - Type UnspecifiedMEDICARE ID