1548234446 NPI number — GREAT HEALTH MEDICAL CENTER INC

Table of content: (NPI 1548234446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548234446 NPI number — GREAT HEALTH MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT HEALTH MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548234446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CANADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91012-0781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-665-5600
Provider Business Mailing Address Fax Number:
323-665-8500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 N VERMONT AVE
Provider Second Line Business Practice Location Address:
#610
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-665-5600
Provider Business Practice Location Address Fax Number:
323-665-8500
Provider Enumeration Date:
02/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MICHEL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-665-5600

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)