Healthcare Provider Details

I. General information

NPI: 1487086989
Provider Name (Legal Business Name): CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 S GRAND AVE
LOS ANGELES CA
90007-2607
US

IV. Provider business mailing address

2614 S. GRAND AVE
LOS ANGELES CA
90007
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-5000
  • Fax: 323-234-3900
Mailing address:
  • Phone: 323-234-5000
  • Fax: 323-234-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NUSRATH FATIMA JAHANGIR
Title or Position: COO
Credential:
Phone: 323-234-5000