Healthcare Provider Details

I. General information

NPI: 1457275539
Provider Name (Legal Business Name): TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E VERNON AVE STE F
LOS ANGELES CA
90011-3772
US

IV. Provider business mailing address

1061 E VERNON AVE STE F
LOS ANGELES CA
90011-3772
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 323-233-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ARAM MANOUKIAN
Title or Position: CEO
Credential:
Phone: 760-326-0222