Provider Demographics
NPI:1992733513
Name:EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL
Entity type:Organization
Organization Name:EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-938-7595
Mailing Address - Street 1:PO BOX 840149
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0149
Mailing Address - Country:US
Mailing Address - Phone:626-732-3100
Mailing Address - Fax:626-732-3195
Practice Address - Street 1:250 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4218
Practice Address - Country:US
Practice Address - Phone:626-963-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMANATE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40597FMedicaid
CAHSC30597FMedicaid
CA1026OtherBLUE CROSS SO CAL
CAZZT30597FMedicaid
CAZZZA1988ZOtherBLUE SHIELD CA
CAZZZA1988ZOtherBLUE SHIELD CA
CA1026OtherBLUE CROSS SO CAL
CAM05097Medicare PIN
CAZZT30597FMedicaid
CA050597Medicare Oscar/Certification