1972954071 NPI number — COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC.

Table of content: (NPI 1972954071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972954071 NPI number — COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE COMMUNITY HEALTH CENTERS, 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:
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:
1972954071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 S CHEVY CHASE DR
Provider Second Line Business Mailing Address:
20
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91205-4431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-630-6130
Provider Business Mailing Address Fax Number:
818-630-7925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8316 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91040-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-630-6106
Provider Business Practice Location Address Fax Number:
818-630-7925
Provider Enumeration Date:
06/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
POLADYAN
Authorized Official First Name:
FLORA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
818-630-6106

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com