Healthcare Provider Details

I. General information

NPI: 1306841036
Provider Name (Legal Business Name): COMMUNITY CARE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

IV. Provider business mailing address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-4222
  • Fax: 714-842-0716
Mailing address:
  • Phone: 714-847-4222
  • Fax: 714-842-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACEY K GOULD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 714-847-4222