Healthcare Provider Details

I. General information

NPI: 1730630997
Provider Name (Legal Business Name): VIA CARE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S ATLANTIC BLVD
LOS ANGELES CA
90022-1733
US

IV. Provider business mailing address

607 S ATLANTIC BLVD
LOS ANGELES CA
90022-3211
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORAH VILLAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 213-268-9191