Provider Demographics
NPI:1144916958
Name:CHARTER OAK HOSPITAL
Entity type:Organization
Organization Name:CHARTER OAK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-966-1632
Mailing Address - Street 1:1161 E COVINA BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1161 E COVINA BLVD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1523
Practice Address - Country:US
Practice Address - Phone:626-966-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251J00000XAgenciesNursing Care