Provider Demographics
NPI:1982629440
Name:EMANATE HEALTH MEDICAL CENTER
Entity Type:Organization
Organization Name:EMANATE HEALTH MEDICAL CENTER
Other - Org Name:CITRUS VALLEY MEDICAL CENTER INTER-COMMUNITY CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-938-7595
Mailing Address - Street 1:PO BOX 840145
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0145
Mailing Address - Country:US
Mailing Address - Phone:626-732-3100
Mailing Address - Fax:
Practice Address - Street 1:210 W SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1515
Practice Address - Country:US
Practice Address - Phone:626-331-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMANATE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30382FMedicaid
CAHSM30382GMedicaid
CAZZT40382GMedicaid
CAZZZC1911ZOtherBLUE SHIELD OF CALIFORNIA
CA002OtherBLUE CROSS SO CALIFORNIA
CAHSC30382GMedicaid
CA002OtherBLUE CROSS SO CALIFORNIA
CAZZZC1911ZOtherBLUE SHIELD OF CALIFORNIA
CAZZT30382FMedicaid
CAZZT40382GMedicaid