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NPI Code Detail

MEDICARE: GARDENA PHYSICIANS HOSPITAL, INC.

MEDICARE: GARDENA PHYSICIANS 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
1314000000XSkilled Nursing FacilityCA
2282N00000XGeneral Acute Care HospitalCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3555525OTHERCAMEDICARE SNF

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568532133
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARDENA PHYSICIANS HOSPITAL, INC.
Provider Business Mailing Address
First Line : 1300 W 155TH ST STE 102
Second Line :
City : GARDENA
State : CA
Zip : 90247-4049
Country : US
Telephone Number : 714-488-3188
Fax Number :
Provider Business Practice Location Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 310-768-2235
Fax Number : 310-768-2265
Authorized Official
Title or Position : PRESIDENT
Name : RAYMOND SMITH
Credential :
Telephone Number : 714-488-3188
Provider Enumeration Date : 11/09/2006
Last Update Date : 10/19/2007

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Directions to “GARDENA PHYSICIANS HOSPITAL, INC. ” Practice Location

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