Healthcare Provider Details

I. General information

NPI: 1811279763
Provider Name (Legal Business Name): BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43322 GINGHAM AVE
LANCASTER CA
93535-4576
US

IV. Provider business mailing address

43322 GINGHAM AVE
LANCASTER CA
93535-4576
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-4050
  • Fax: 661-942-3500
Mailing address:
  • Phone: 661-874-4050
  • Fax: 661-942-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARY CUMMINGS
Title or Position: CEO
Credential:
Phone: 661-466-3895