Healthcare Provider Details

I. General information

NPI: 1346951654
Provider Name (Legal Business Name): COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9043 WOODMAN AVE STE C
ARLETA CA
91331-6493
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 20
GLENDALE CA
91205-4437
US

V. Phone/Fax

Practice location:
  • Phone: 818-221-9096
  • Fax:
Mailing address:
  • Phone: 818-630-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORA POLADYAN
Title or Position: COO
Credential:
Phone: 818-630-6106