1801965330 NPI number — EL DORADO COMMUNITY SERVICE CENTERERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801965330 NPI number — EL DORADO COMMUNITY SERVICE CENTERERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL DORADO COMMUNITY SERVICE CENTERERS
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:
HOLLYWOOD MEDICAL & MENTAL HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1801965330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 801809
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91380-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-653-1677
Provider Business Mailing Address Fax Number:
323-653-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5015 W PICO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90019-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-653-1677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
STAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
661-254-6630

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  960001104 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103244 . This is a "LADMH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMM70807F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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