Healthcare Provider Details

I. General information

NPI: 1114774023
Provider Name (Legal Business Name): COMMUNITY HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8874 S BROADWAY
LOS ANGELES CA
90003-3635
US

IV. Provider business mailing address

8874 S BROADWAY
LOS ANGELES CA
90003-3635
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-9372
  • Fax: 323-295-9467
Mailing address:
  • Phone: 323-295-9372
  • Fax: 323-295-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LEAH MICHELLE BURTON
Title or Position: CEO
Credential: PHD
Phone: 323-295-9372