=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225120710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAHEIM GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 12/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 WEST BALL ROAD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-947-5800
-----------------------------------------------------
Fax | 949-732-4671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 WEST BALL ROAD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-947-5800
-----------------------------------------------------
Fax | 949-732-4671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/HOSPITAL CFO
-----------------------------------------------------
Name | MS. CLARA RUTH BLOM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-463-8273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------