Provider Demographics
NPI:1720371065
Name:LONG BEACH MEMORIAL MEDICAL
Entity Type:Organization
Organization Name:LONG BEACH MEMORIAL MEDICAL
Other - Org Name:COMMUNITY HOSPITAL LONG BEACH
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 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-5437
Mailing Address - Fax:562-933-8016
Practice Address - Street 1:1720 TERMINO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-498-1000
Practice Address - Fax:562-933-8016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG BEACH MEMORIAL MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-19
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40004FMedicaid
CAHSP30004FMedicaid
CAHSP30004FMedicaid