Provider Demographics
NPI:1922048511
Name:SADDLEBACK MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SADDLEBACK MEMORIAL MEDICAL CENTER
Other - Org Name:MEMORIALCARE HOSPICE AND PALLIATIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-377-3218
Mailing Address - Street 1:24411 HEALTH CENTER DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3629
Mailing Address - Country:US
Mailing Address - Phone:949-450-3000
Mailing Address - Fax:949-380-4576
Practice Address - Street 1:24411 HEALTH CENTER DRIVE SUITE 400
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-450-3000
Practice Address - Fax:949-380-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000218251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01595FMedicaid
CA051595Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER