1720115033 NPI number — FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC

Table of content: (NPI 1720115033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720115033 NPI number — FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, 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:
6
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:
1720115033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6001 E WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-928-9600
Provider Business Mailing Address Fax Number:
562-927-6974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501 GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELL GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-928-9600
Provider Business Practice Location Address Fax Number:
562-927-8603
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VILLA
Authorized Official First Name:
RAQUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
562-928-9600

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  960000881 , 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: FHC70574F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BU386A . This is a "GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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