1649614843 NPI number — KEDREN COMMUNITY MENTAL HEALTH CENTER

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 1649614843 NPI number — KEDREN COMMUNITY MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEDREN COMMUNITY MENTAL HEALTH CENTER
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:
1649614843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 AVALON BLVD
Provider Second Line Business Mailing Address:
HR DEPARTMENT
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90011-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-582-2251
Provider Business Mailing Address Fax Number:
323-582-2251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 VENICE 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:
90006-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-802-0264
Provider Business Practice Location Address Fax Number:
323-802-0264
Provider Enumeration Date:
04/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
HILDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING SERVICES
Authorized Official Telephone Number:
323-802-0264

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  930000028 , 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)





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