MEDICARE: LOS ANGELES CHRISTIAN HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	96000972	CA

General Provider Information

NPI Number	:	1225382955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES CHRISTIAN HEALTH CENTERS

Provider Business Mailing Address
First Line	:	453 S SPRING ST STE 1201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-2093
Country	:	US
Telephone Number	:	213-893-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-1390
Country	:	US
Telephone Number	:	213-893-1960
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BETTINA LEWIS
Credential	:
Telephone Number	:	213-893-1960

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	04/29/2021

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