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DSH050069Z ST. JOSEPH HOSPITAL OF ORANGE (Terminated)
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Main Details
Name
ST. JOSEPH HOSPITAL OF ORANGE
Subdivision Name
Surgery Center - SJOP
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050069Z
Medicare Provider Number
050069
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2014
Participating Start Date
4/1/2014
Participating Approval Date
1/15/2014
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
1/1/2018
For-Profit conversion
Contacts
Authorizing Official
St. Joseph Hospital, Orange
Kristi Liberatore, Chief Financial Officer
(714) 771-8281
Primary Contact
St. Joseph Hospital, Orange
Sy Amirpoor, Director of Pharmacy Services
(714) 771-8278
Addresses
Street Address
1140 W. La Veta Ave
Orange, CA 92868
Billing Address
St. Joseph Hospital of Orange
1100 West Stewart
Orange, CA 92868
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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