Provider Demographics
NPI:1871501916
Name:PRIME HEALTHCARE ANAHEIM, LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE ANAHEIM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4327
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4400
Mailing Address - Fax:909-235-4419
Practice Address - Street 1:3033 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3156
Practice Address - Country:US
Practice Address - Phone:714-827-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000182282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05S426Medicare Oscar/Certification
CA050426Medicare Oscar/Certification