Healthcare Provider Details

I. General information

NPI: 1316332661
Provider Name (Legal Business Name): KEDREN COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E 60TH ST
LOS ANGELES CA
90001-1017
US

IV. Provider business mailing address

4211 SOUTH AVALON BOULEVARD
LOS ANGELES CA
90011-0000
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-0425
  • Fax:
Mailing address:
  • Phone: 323-432-5093
  • Fax: 323-232-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HILDA RODRIGUEZ
Title or Position: DIRECTOR OF BILLING SERVICES
Credential:
Phone: 323-802-0264