Healthcare Provider Details

I. General information

NPI: 1437482635
Provider Name (Legal Business Name): KEDREN MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W ADAMS BLVD
LOS ANGELES CA
90018-2039
US

IV. Provider business mailing address

8927 RAMSGATE AVE
LOS ANGELES CA
90045-4611
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-3886
  • Fax:
Mailing address:
  • Phone: 310-686-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KEDREN CENTER
Title or Position: CASE MANAGER
Credential: BSW
Phone: 323-733-3886