Healthcare Provider Details

I. General information

NPI: 1356763155
Provider Name (Legal Business Name): UNICARE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E HOLT AVE STE A
POMONA CA
91767-5823
US

IV. Provider business mailing address

437 N EUCLID AVE
ONTARIO CA
91762-3456
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-3600
  • Fax: 909-623-3383
Mailing address:
  • Phone: 909-988-2555
  • Fax: 909-391-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: AVETIK MACHKALYAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 909-623-3600