NPIMap

Organization Active NPI

Prime Healthcare Services - Garden Grove LLC

Doing business as Garden Grove Hospital Medical Center

  • Psychiatric Hospital Unit
  • Garden Grove, CA
National Provider Identifier
1003688953
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC
Doing business as
Garden Grove Hospital Medical Center
Practice address
12601 Garden Grove Blvd
Garden Grove, CA 92843-1908
Phone
(714) 741-2700
NPI assigned
Oct 24, 2023
Last updated
Oct 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Doan
Title
Managing Associate General Counsel
Phone
(310) 259-4706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

12601 Garden Grove Blvd
Garden Grove, CA 92843-1908

Mailing address

12601 Garden Grove Blvd
Garden Grove, CA 92843-1908
Phone (714) 741-2700

Other names 1

  • Garden Grove Hospital Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250513000379 CA Part A Provider - Hospital 7012089600 Practice locations: Garden Grove, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003688953. Details of each certification follow.

Hospital certification: CCN 05S230

Legal name
PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC
Doing business as
GARDEN GROVE HOSPITAL AND MEDICAL CENTER
Organization structure
LLCProprietary
Enrollment address
12601 Garden Grove Blvd
Garden Grove, CA 92843-1908
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services - Garden Grove LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Dan Brothman Individual Corporate OfficerChief Executive Officer Jan 1, 2023
Corporate DirectorDirector Jan 1, 2023
W-2 Managing EmployeeAd;Chief Executive Officer Jan 1, 2023
Steven Aleman Individual Corporate OfficerCorporate Chief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerManaging Associate General Counsel Apr 24, 2017
Prime Healthcare Holdings Inc Organization, Ontario, CA Corporation, Holding company 5% Or Greater Indirect Ownership Interest Jul 1, 2008 100%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Garden Grove Hospital and Medical CenterGarden Grove, CA, CCN 050230 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 77

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 77

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1003688953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12601 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431908",
            "telephone_number": "714-741-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12601 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431908",
            "telephone_number": "714-741-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden Grove Hospital Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.