Provider Demographics
NPI:1306991278
Name:KAISER FOUNDATION HOSPITALS
Entity type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR ARL
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RN, CPHQ
Authorized Official - Phone:626-405-3676
Mailing Address - Street 1:17046 MARYGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-1706
Mailing Address - Country:US
Mailing Address - Phone:909-427-5128
Mailing Address - Fax:
Practice Address - Street 1:17046 MARYGOLD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1706
Practice Address - Country:US
Practice Address - Phone:909-427-5128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000159324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555111Medicare Oscar/Certification