=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316332661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEDREN COMMUNITY HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2015
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 918 E 60TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90001-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-233-0425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4211 SOUTH AVALON BOULEVARD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90011-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-432-5093
-----------------------------------------------------
Fax | 323-232-2384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BILLING SERVICES
-----------------------------------------------------
Name | HILDA RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-802-0264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------