Healthcare Provider Details

I. General information

NPI: 1992269757
Provider Name (Legal Business Name): LOS ANGELES CHRISTIAN HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 7TH ST
LOS ANGELES CA
90014-2209
US

IV. Provider business mailing address

315 W 9TH ST STE 950
LOS ANGELES CA
90015-4213
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-1960
  • Fax:
Mailing address:
  • Phone: 213-893-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERICA DUBOSE
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 562-338-4774