Healthcare Provider Details

I. General information

NPI: 1952012379
Provider Name (Legal Business Name): CPH HOSPITAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 STUDEBAKER RD
NORWALK CA
90650-2531
US

IV. Provider business mailing address

898 N PACIFIC COAST HWY STE 700
EL SEGUNDO CA
90245-2742
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-3751
  • Fax:
Mailing address:
  • Phone: 310-356-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MARK EDWARD DAKICH
Title or Position: MANAGER OF LEGAL AFFAIRS
Credential:
Phone: 310-356-0514