Provider Demographics
NPI:1215903018
Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZDEBLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-652-5011
Mailing Address - Street 1:147 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2809
Mailing Address - Country:US
Mailing Address - Phone:805-652-5011
Mailing Address - Fax:805-585-3007
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2809
Practice Address - Country:US
Practice Address - Phone:805-652-5011
Practice Address - Fax:805-585-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30394FMedicaid
CARHM18553HMedicaid
CA050394OtherBLUE CROSS PROVIDER NO
CAZZZ53994ZOtherBLUE SHIELD
CARHM08608FMedicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CAZZZA5603ZOtherBLUE SHIELD
CA050394Medicare Oscar/Certification
CA050394OtherBLUE CROSS PROVIDER NO