Healthcare Provider Details

I. General information

NPI: 1114132685
Provider Name (Legal Business Name): ALTA LOS ANGELES HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 E OLYMPIC BLVD
LOS ANGELES CA
90023-3330
US

IV. Provider business mailing address

4081 E OLYMPIC BLVD
LOS ANGELES CA
90023-3330
US

V. Phone/Fax

Practice location:
  • Phone: 323-881-2600
  • Fax: 323-261-0809
Mailing address:
  • Phone: 323-881-2600
  • Fax: 323-261-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number930000039
License Number StateCA

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249