1679810345 NPI number — COMPASSION CARE CENTER

Table of content: (NPI 1679810345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679810345 NPI number — COMPASSION CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSION CARE 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:
1679810345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2614 CRENSHAW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90016-3057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-230-5574
Provider Business Mailing Address Fax Number:
323-373-9786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 S SOTO ST
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:
90023-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-230-5574
Provider Business Practice Location Address Fax Number:
323-373-9786
Provider Enumeration Date:
01/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESTER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
310-230-5574

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  19748 , 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: 7458 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".