1952716441 NPI number — QUEENSCARE HEALTH CENTERS

Table of content: (NPI 1952066409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952716441 NPI number — QUEENSCARE HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEENSCARE HEALTH CENTERS
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:
1952716441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 S GRAND AVE
Provider Second Line Business Mailing Address:
2ND FLOOR SOUTH
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90015-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-669-4326
Provider Business Mailing Address Fax Number:
323-953-3658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4618 FOUNTAIN AVE
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:
90029-1977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-953-7170
Provider Business Practice Location Address Fax Number:
323-669-2379
Provider Enumeration Date:
06/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HINES
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
323-669-4305

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 55-1895 . This is a "MEDICARE FQHC PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMM70660F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W6997D . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC70660F . This is a "MEDI-CAL FQHC PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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