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RRC050567-20 MISSION HOSPITAL REG MEDICAL CENTER (Active)
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Main Details
Name
MISSION HOSPITAL REG MEDICAL CENTER
Subdivision Name
MISSION HOSPITAL - MISSION HOSPITAL LAGUNA Beach - Physical Therapy and Rehab Services
Type
Rural Referral Center
Rural
Yes
340B ID
RRC050567-20
Medicare Provider Number
050567
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/5/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/4/2020
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
St. Joseph Hospital, Orange
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Primary Contact
Mission Hospital
Nha-Uyen Tran, 340B Pharmacist Specialist
(949) 364-1400 Ext: 2220
Addresses
Street Address
31872 COAST HWY
LAGUNA BEACH, CA 92651-6773
Billing Address
St. Joseph Health Shared Services Accounts Payable
3345 Michelson Drive
Irvine, CA 92612
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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