MEDICARE: ALTA LOS ANGELES HOSPITAL, 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	314000000X	Skilled Nursing Facility	930000039	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

General Provider Information

NPI Number	:	1114132685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA LOS ANGELES HOSPITAL, INC

Provider Business Mailing Address
First Line	:	4081 E OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3330
Country	:	US
Telephone Number	:	323-881-2600
Fax Number	:	323-261-0809

Provider Business Practice Location Address
First Line	:	4081 E OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3330
Country	:	US
Telephone Number	:	323-881-2600
Fax Number	:	323-261-0809

Authorized Official
Title or Position	:	SECRETARY
Name	:	ROBERT JON ELDERS
Credential	:
Telephone Number	:	714-788-1249

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	02/04/2021

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