MEDICARE: SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	930000066	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZC9928Z	OTHER	CA	BLUE SHEILD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023010113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC

Provider Business Mailing Address
First Line	:	3415 S SEPULVEDA BLVD FL 9
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6060
Country	:	US
Telephone Number	:	310-943-4500
Fax Number	:	310-943-4501

Provider Business Practice Location Address
First Line	:	6245 DE LONGPRE AVE
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-462-2271
Fax Number	:	323-463-3830

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JON ZILKOW
Credential	:
Telephone Number	:	310-943-4500

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/04/2021

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