Provider Demographics
NPI:1942240007
Name:LONG BEACH MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:LONG BEACH MEMORIAL MEDICAL CENTER
Other - Org Name:MEMORIAL HOSPICE PROGRAM
Other - Org Type:Other Name
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 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1737
Mailing Address - Country:US
Mailing Address - Phone:562-933-2000
Mailing Address - Fax:562-933-1107
Practice Address - Street 1:695 E 27TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90755
Practice Address - Country:US
Practice Address - Phone:562-933-4663
Practice Address - Fax:562-933-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000516251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01563FMedicaid
CA051563Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER