Healthcare Provider Details

I. General information

NPI: 1568487619
Provider Name (Legal Business Name): SAN DIMAS COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W COVINA BLVD
SAN DIMAS CA
91773-3245
US

IV. Provider business mailing address

FILE 57543
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-6811
  • Fax:
Mailing address:
  • Phone: 626-300-4122
  • Fax: 626-300-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number93000039
License Number StateCA

VIII. Authorized Official

Name: MR. CRAIG C. ARMIN
Title or Position: VP OF GOVT PROGRAMS, TENET
Credential:
Phone: 310-775-8043