Provider Demographics
NPI:1831356286
Name:PERRIS VALLEY COMMUNITY HOSPITAL LLC
Entity type:Organization
Organization Name:PERRIS VALLEY COMMUNITY HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR V-P
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-436-3535
Mailing Address - Street 1:2224 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2638
Mailing Address - Country:US
Mailing Address - Phone:951-436-3535
Mailing Address - Fax:
Practice Address - Street 1:2224 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2638
Practice Address - Country:US
Practice Address - Phone:951-436-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000234282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30759FMedicaid
CAHSP40759FMedicaid
CA052052Medicare Oscar/Certification