Provider Demographics
NPI:1033271176
Name:HALLMARK SURGICAL CENTER OF NORTHRIDGE
Entity type:Organization
Organization Name:HALLMARK SURGICAL CENTER OF NORTHRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-718-8450
Mailing Address - Street 1:8327 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4620
Mailing Address - Country:US
Mailing Address - Phone:818-718-8450
Mailing Address - Fax:818-718-8456
Practice Address - Street 1:8327 RESEDA BOULEVARD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4620
Practice Address - Country:US
Practice Address - Phone:818-718-8450
Practice Address - Fax:818-718-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051413AMedicare ID - Type Unspecified