NPIMap

Organization Active NPI

Alta Los Angeles Hospital, Inc

Doing business as Los Angeles Hospital

  • Skilled Nursing Facility
  • Los Angeles, CA
National Provider Identifier
1114132685
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
930000039 Issued in CA
Legal business name
ALTA LOS ANGELES HOSPITAL, INC
Doing business as
Los Angeles Hospital
Practice address
4081 E Olympic Blvd
Los Angeles, CA 90023-3330
Phone
(323) 881-2600
Fax
(323) 261-0809
NPI assigned
May 10, 2007
Last updated
Feb 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 930000039 CA Primary

Addresses

Primary practice location

4081 E Olympic Blvd
Los Angeles, CA 90023-3330

Mailing address

4081 E Olympic Blvd
Los Angeles, CA 90023-3330
Phone (323) 881-2600

Other identifiers 1

IdentifierTypeStateIssuer
LTC70086FMedicaidCA

Other names 1

  • LOS ANGELES HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041005000827 CA Part A Provider - Hospital 0547229650 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellflower, CA; Los Angeles, CA; Norwalk, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114132685. Details of each certification follow.

Hospital certification: CCN 050663

Legal name
ALTA LOS ANGELES HOSPITALS, INC.
Doing business as
LOS ANGELES COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 19, 1983
Last certification
Dec 23, 2022
Beds
180 (150 certified)
Ownership / control type
Private (for profit)
Most recent change of ownership
Oct 1, 1998 (1 total)
Organization structure
CorporationProprietary
Incorporated
Jun 10, 1998 in CA
Enrollment address
4081 E Olympic Blvd
Los Angeles, CA 90023-3330
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Los Angeles Community HospitalCCN 050663 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

11180 Warner Ave
Ste 161
Fountain Vly, CA 92708
Phone (714) 556-8320

3300 E South St
Ste 110
Lakewood, CA 90805
Phone (213) 630-7279

4160 Wilshire Blvd
Ste 302
Los Angeles, CA 90010
Phone (323) 965-9645

101 E Beverly Blvd
Ste 200
Montebello, CA 90640
Phone (213) 726-7535

850 S Atlantic Blvd
Ste 302
Monterey Park, CA 91754
Phone (626) 281-8835

10210 Orr and Day Rd
Ste A
Santa Fe Springs, CA 90670
Phone (562) 863-8774

5225 Lindley Ave
Tarzana, CA 91356

2841 Lomita Blvd
Ste 215
Torrance, CA 90505
Phone (310) 379-2860

910 S Sunset Ave
Ste 2
West Covina, CA 91790
Phone (626) 859-4167

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Sang Bum Lee Individual 5% Or Greater Indirect Ownership Interest Aug 8, 2012 66.67%
Corporate OfficerPres/Board Member Aug 8, 2007
Corporate DirectorPres/Board Member Aug 8, 2008
Robert Elders Individual Corporate OfficerSecretary Jun 15, 2020
JP Morgan Chase, N.a. Organization, Columbus, OH Financial institution 5% Or Greater Security Interest Jun 30, 2016 100%
MPT of Los Angeles PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%
Eric Samuels Individual Corporate OfficerTreasurer Jun 3, 2019
Carmelo a James Individual W-2 Managing EmployeeHospital Cno Sep 15, 2016
Ivy Intermediate Holding Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Dec 15, 2010 100%
Alfredo Sabillo Individual Corporate OfficerAssistant Treasurer Jul 21, 2020
Mark Johnson Individual Corporate OfficerSVP Jul 27, 2020
Ivy Holdings Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Dec 15, 2010 100%
William M Gorenstein Individual Corporate OfficerSVP Aug 15, 2016
Alta Hospitals System LLC Organization, Los Angeles, CA For-profit 5% Or Greater Direct Ownership Interest Jun 5, 2007 100%
Hector G Hernandez Individual W-2 Managing EmployeeHospital Ceo May 23, 2016
David & Alexa Topper Family Trust Organization, Beverly Hills, CA 5% Or Greater Indirect Ownership Interest Dec 15, 2012 33.33%
MPT of Norwalk PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%
MPT of Bellflower PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%
David R Topper Individual Corporate OfficerCeo/Board Member Aug 8, 2007
Corporate DirectorCeo/Board Member Aug 8, 2007
Other Dec 15, 2010
Chamber Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2021 100%
Prospect Medical Holdings Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Aug 8, 2007 100%

Practitioners & affiliated clinicians

Practitioners 84

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.

View all 84

Affiliated clinicians 148

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 148

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1114132685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4081 E OLYMPIC BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900233330",
            "telephone_number": "323-881-2600",
            "fax_number": "323-261-0809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4081 E OLYMPIC BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900233330",
            "telephone_number": "323-881-2600",
            "fax_number": "323-261-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA LOS ANGELES HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "930000039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC70086F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOS ANGELES HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LOS ANGELES HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.