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General NPI Number Information
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NPI Number | 1134336811
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Entity Type | Organization
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Legal Business Name | KEDREN COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 918 E 60TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90001-1017
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Country | US
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Telephone | 323-233-0425
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Fax | 323-233-5186
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Provider Business Mailing Address
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Address Line | 4211 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5622
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Country | US
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Telephone | 323-432-5093
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Fax | 323-233-5015
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Authorized Official
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Title or Position | DIRECTOR OF BILLING SERVICES
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Name | HILDA RODRIGUEZ
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Credential |
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Telephone | 323-802-0264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 930000028
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License Number State | CA
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