Healthcare Provider Details

I. General information

NPI: 1467752626
Provider Name (Legal Business Name): ALL CARE ONE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANTA FE AVE.
HUNTINGTON PARK CA
90255-7531
US

IV. Provider business mailing address

7300 SANTA FE AVE.
HUNTINGTON PARK CA
90255-5731
US

V. Phone/Fax

Practice location:
  • Phone: 323-277-8900
  • Fax: 323-277-8902
Mailing address:
  • Phone: 323-277-8900
  • Fax: 323-277-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KONONENKO
Title or Position: CFO
Credential:
Phone: 323-277-8900