Healthcare Provider Details

I. General information

NPI: 1487531737
Provider Name (Legal Business Name): URBAN COMMUNITY ACTION NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 W MANCHESTER AVE STE 201
LOS ANGELES CA
90045-4423
US

IV. Provider business mailing address

5710 W MANCHESTER AVE STE 201
LOS ANGELES CA
90045-4423
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-8951
  • Fax:
Mailing address:
  • Phone: 213-700-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. DEJUAN VERRETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-700-8951