NPIMap

Organization Active NPI

Prime Healthcare Services - Garden Grove LLC

  • General Acute Care Hospital
  • Garden Grove, CA
National Provider Identifier
1659538858
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC
Practice address
12601 Garden Grove Blvd
Garden Grove, CA 92843-1908
Phone
(714) 537-5160
Fax
(909) 464-8887
NPI assigned
May 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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
General Acute Care Hospital 282N00000X 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
O20080626000071 CA Part A Provider - Hospital 7012089600 Practice locations: Garden Grove, CA

Hospital certification: CCN 050230

Legal name
PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC
Doing business as
GARDEN GROVE HOSPITAL AND MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 7, 1969
Last certification
Aug 23, 2023
Beds
167
Ownership / control type
Private (for profit)
Most recent change of ownership
Jul 1, 2008 (1 total)
Organization structure
LLCProprietary
Incorporated
May 6, 2008 in DE
Enrollment address
12601 Garden Grove Blvd
Garden Grove, CA 92843-1908
Main/Primary Hospital Location
Hospital subgroups
Acute care

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Garden Grove Hospital & Medical CenterCCN 050230
Overall star rating
2 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

Ownership & related parties

All disclosed owners & managing parties 7

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, Onterio, CA 5% Or Greater Indirect Ownership Interest Jul 1, 2008 100%
Other Nov 1, 2007
Dan Brothman Individual Corporate OfficerChief Executive Officer Jan 1, 2023
Corporate DirectorChairperson Jan 1, 2023
W-2 Managing EmployeeChief Executive Officer Jan 1, 2023
Luis Leon Individual Corporate OfficerCorporate Chief Executive Officer Jun 1, 2020
Steven Aleman Individual Corporate OfficerChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Prime Healthcare Services - Garden Grove LLC Organization, Garden Grove, CA Created for acquisition, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Prime Healthcare Holdings Inc Organization, Onterio, CA Corporation 5% Or Greater Indirect Ownership Interest Apr 21, 2010 100%

Owners & managing parties with NPI records 1

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

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

Affiliated clinicians 98

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

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572480000000",
    "number": "1659538858",
    "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",
            "fax_number": "714-741-3370"
        },
        {
            "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": "714-537-5160",
            "fax_number": "909-464-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - GARDEN GROVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2019-10-31",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden Grove Hospital & Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "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.