Provider Demographics
NPI:1811929359
Name:SAN DIMAS COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:SAN DIMAS COMMUNITY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-775-8043
Mailing Address - Street 1:FILE 57543
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:626-300-4122
Mailing Address - Fax:909-599-0629
Practice Address - Street 1:1350 W COVINA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3245
Practice Address - Country:US
Practice Address - Phone:909-599-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93000039282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
95-3783605OtherINTER VALLEY HEALTH PLAN
95-3783616OtherWELLPOINT HEALTH NETWORKS
000410OtherHUMANA
578531560OtherAETNA US HEALTHCARE
95-3783606OtherINTERPLAN
050588B000000OtherSECTION 1011
95-3783611OtherPRIVATE HEALTHCARE SYSTEM
CAHSP40588GMedicaid
CAX-0220213Medicaid
005316-0001OtherPACIFICARE OF CALIFORNIA
95-3783614OtherTENET EMPLOYEES BENEFIT P
CAHSC30588GMedicaid
199470000OtherDEPT OF LABOR
8423OtherHEALTH NET
95-3783607OtherKAISER FOUNDATION HEALTH
95-3783608OtherLOS ANGELES FOUNDATION FO
95-3783602OtherBEECH STREET HEALTHCARE
ZZZA2019ZOtherBS OF CALIFORNIA
CAHSP40588GMedicaid
8423OtherHEALTH NET