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General NPI Number Information
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NPI Number | 1750491247
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES - SHERMAN OAKS, LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 4929 VAN NUYS BLVD.
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1702
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Country | US
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Telephone | 818-981-7111
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Fax | 818-501-6430
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Provider Business Mailing Address
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Address Line | 3300 E GUASTI RD 3RD FLOOR
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City | ONTARIO
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State | CA
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Zip | 91761-8655
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Country | US
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Telephone | 909-235-4400
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Fax | 909-235-4419
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Authorized Official
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Title or Position | CHAIRMAN/PRES/CEO
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Name | PREM REDDY
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Credential | MD, FACC, FCCP
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Telephone | 909-235-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 930000149
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License Number State | CA
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