Healthcare Provider Details

I. General information

NPI: 1497001226
Provider Name (Legal Business Name): VIA CARE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S ATLANTIC BLVD
LOS ANGELES CA
90022-2621
US

IV. Provider business mailing address

507 S ATLANTIC BLVD
LOS ANGELES CA
90022-2621
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax: 323-268-9119
Mailing address:
  • Phone: 323-268-9191
  • Fax: 323-268-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: NINA FALCETTI
Title or Position: DIRECTOR OF HR
Credential:
Phone: 323-268-9191