NPIMap

Organization Active NPI

Antelope Valley Health Care District

  • General Acute Care Hospital
  • Lancaster, CA
National Provider Identifier
1366419517
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
930000008 Issued in CA
Legal business name
ANTELOPE VALLEY HEALTH CARE DISTRICT
Practice address
1600 W Avenue J
Lancaster, CA 93534-2814
Phone
(661) 949-5000
Fax
(661) 949-5774
NPI assigned
Mar 7, 2006
Last updated
Dec 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

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

Authorized official

Name
Ms. Kristina HongNPI 1891209219
Title
Board of Directors- Chair
Phone
(661) 949-5512

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 930000008 CA Primary

Addresses

Primary practice location

1600 W Avenue J
Lancaster, CA 93534-2814

Mailing address

1600 W Avenue J
Lancaster, CA 93534-2814
Phone (661) 949-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030415000006 CA Part A Provider - Hospital 7618886532 Practice locations: Lancaster, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366419517. Details of each certification follow.

Hospital certification: CCN 050056

Legal name
ANTELOPE VALLEY HEALTH CARE DISTRICT
Doing business as
ANTELOPE VALLEY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 21, 2022
Beds
341
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
1600 W Avenue J
Lancaster, CA 93534-2814
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric unit

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Antelope Valley HospitalCCN 050056 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Antelope Valley Hospital OB Clinic Lancaster5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

15503 Ventura Blvd
Ste 200
Encino, CA 91436
Phone (818) 788-7288

1672 W Avenue J
Ste 209
Lancaster, CA 93534
Phone (661) 729-6854

42543 8th St W
Ste 101
Lancaster, CA 93534
Phone (661) 948-4373

43932 15th St W
Ste 101
Lancaster, CA 93534
Phone (661) 726-6565

44215 15th St W
Ste 109
Lancaster, CA 93534
Phone (661) 948-5723

44215 15th St W
Ste 110
Lancaster, CA 93534
Phone (661) 945-7802

44241 15th St W
Ste 206
Lancaster, CA 93534
Phone (661) 726-6490

44241 15th St W
Ste 303
Lancaster, CA 93534
Phone (661) 948-4691

44725 10th St W
Ste 120
Lancaster, CA 93534
Phone (661) 522-3256

1245 Wilshire Blvd
Ste 580
Los Angeles, CA 90017
Phone (213) 977-0419

28078 Baxter Rd
Ste 140
Murrieta, CA 92563
Phone (760) 733-9191

1037 W Avenue N
Ste 202
Palmdale, CA 93551
Phone (661) 266-8400

1224 E Avenue S
Ste A
Palmdale, CA 93550
Phone (661) 274-8666

623 W Avenue Q
Ste A
Palmdale, CA 93551
Phone (661) 726-6255

2222 Santa Monica Blvd
Ste 107
Santa Monica, CA 90404
Phone (310) 496-3770

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ayako Smith Individual Corporate OfficerChief Nursing Officer Nov 1, 2018
W-2 Managing EmployeeChief Nursing Officer/ Coo Nov 1, 2018
Kristina S Hong Individual Corporate DirectorBoard of Directors- Chair Nov 1, 2016
Abdallah Sad-Ud Din Farrukh Individual Corporate Director Oct 25, 2007
Philip J Tuso Individual Corporate Director Feb 1, 2018
Don V Parazo Individual Corporate Director Oct 25, 2007
Edward Mirzabegian Individual Corporate OfficerChief Executive Officer Jan 4, 2019
W-2 Managing EmployeeChief Executive Officer Jan 4, 2019
Antelope Valley Health Care District Organization, Lancaster, CA Operational/Managerial Control Jan 1, 1966 100%
Mateo Olivarez Individual Corporate Director Nov 1, 2016

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 148

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 148

Affiliated clinicians 299

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

View all 299

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1366419517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W AVENUE J",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342814",
            "telephone_number": "661-949-5000",
            "fax_number": "661-949-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W AVENUE J",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342814",
            "telephone_number": "661-949-5000",
            "fax_number": "661-949-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "HONG",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "BOARD OF DIRECTORS- CHAIR",
        "authorized_official_telephone_number": "661-949-5512",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "930000008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.