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Antelope Valley Health Care District

Organization Active NPI General Acute Care Hospital · Lancaster, CA

NPI 1366419517 · NPPES record last updated Dec 3, 2018

Key facts

NPI
1366419517
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
930000008 (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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 6

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

Other NPIs with the same Medicare PAC ID 2

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

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.

Corporate family (same tax ID) 4

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

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 148

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 148

Affiliated clinicians 300

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

View all 300

Medicare Care Compare: Hospital

Listed as
Antelope Valley Hospital CCN 050056
Overall star rating
★☆☆☆☆ 1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

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
Other · Non-profit
Enrollment address
1600 W Avenue J
Lancaster, CA 93534-2814
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric unit

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 Officer
Chief Nursing Officer		 Nov 1, 2018
W-2 Managing Employee
Chief Nursing Officer/ Coo		 Nov 1, 2018
Kristina S Hong
Individual 		Corporate Director
Board 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 Officer
Chief Executive Officer		 Jan 4, 2019
W-2 Managing Employee
Chief 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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Antelope Valley Hosp-ER (5 organizations share this tax ID)

Locations

191 S Buena Vista St
Ste 200
Burbank, CA 91505
Phone (818) 887-2671

42135 10th St W
Ste 101
Lancaster, CA 93534
Phone (661) 341-3800

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

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

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

44215 15th St W
Ste 111
Lancaster, CA 93534
Phone (661) 949-5941

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

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

1669 W Avenue J
Ste 304
Lancaster, CA 93534
Phone (661) 951-7888

43944 15th St W
Ste 201
Lancaster, CA 93534
Phone (661) 529-7550

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

38780 Trade Center Dr
Ste 1C
Palmdale, CA 93551
Phone (661) 947-5600

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

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

101 Addison Ave
Palo Alto, CA 94301
Phone (650) 433-8621

105 E Sydnor Ave
Ste 100
Ridgecrest, CA 93555
Phone (760) 446-6404

2021 Santa Monica Blvd
Ste 600E
Santa Monica, CA 90404
Phone (310) 828-2282

27420 Tourney Rd
Ste 260
Valencia, CA 91355
Phone (661) 254-7200

2340 E Calvada Blvd
Ste 2
Pahrump, NV 89048
Phone (775) 727-0146

Specialties & licenses

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

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

Other identifiers

IdentifierTypeStateIssuer
HSM60056FMedicaidCA
ZZT30056FMedicaidCA
HSC30056FMedicaidCA
ZZT40056FMedicaidCA

Other providers in Lancaster, CA

All providers in Lancaster, CA · General Acute Care Hospital in California

Sources for this page

Verify at the official NPI Registry.