Healthcare Provider Details

I. General information

NPI: 1982935565
Provider Name (Legal Business Name): CALIFORNIA MENTAL HEALTH CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 CALLE PARRAL
WEST COVINA CA
91792-2182
US

IV. Provider business mailing address

714 N SUNSET AVE
WEST COVINA CA
91790-1227
US

V. Phone/Fax

Practice location:
  • Phone: 626-430-0474
  • Fax: 626-430-0474
Mailing address:
  • Phone: 626-430-0474
  • Fax: 626-430-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number198601281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number198601281
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number198601281
License Number StateCA

VIII. Authorized Official

Name: MR. VAHE A HAKIMIAN
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 626-203-1449