Provider Demographics
NPI:1265529002
Name:COMMUNITY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-652-5003
Mailing Address - Street 1:852 W VENTURA ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1837
Mailing Address - Country:US
Mailing Address - Phone:805-524-9461
Mailing Address - Fax:805-524-9451
Practice Address - Street 1:852 W VENTURA ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1837
Practice Address - Country:US
Practice Address - Phone:805-524-9461
Practice Address - Fax:805-524-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 438010Medicaid