Healthcare Provider Details

I. General information

NPI: 1316248701
Provider Name (Legal Business Name): PRIME HEALTHCARE ANAHEIM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

IV. Provider business mailing address

3300 E GUASTI RD 3RD FLOOR
ONTARIO CA
91761-8655
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 909-235-4400
  • Fax: 909-235-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number060000182
License Number StateCA

VIII. Authorized Official

Name: TROY A. SCHELL
Title or Position: SECRETARY / GENERAL COUNSEL
Credential:
Phone: 909-235-4327