Provider Demographics
NPI:1487706347
Name:COMMUNITY HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:NANETTE
Authorized Official - Last Name:HOLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-571-2300
Mailing Address - Street 1:21801 ALESSANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8202
Mailing Address - Country:US
Mailing Address - Phone:951-571-2300
Mailing Address - Fax:951-571-2330
Practice Address - Street 1:18601 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-1831
Practice Address - Country:US
Practice Address - Phone:909-546-7520
Practice Address - Fax:909-877-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40093122300000X
CA468941223G0001X
CA409961223G0001X
CA479871223P0221X
CAOPT12626TPA152W00000X
CA387455207Q00000X
CAA98737207Q00000X
CAA110976207Q00000X
CAA87726207Q00000X
CA506572207Q00000X
CAA1157855207Q00000X
CA240000086261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70324FMedicaid
CAEAP70324FMedicaid
CAHAP70324FMedicaid
CANPI 1487706347Medicaid
CANPI 1487706347Medicaid
CAEAP70324FMedicaid