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General NPI Number Information
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NPI Number | 1467752626
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Entity Type | Organization
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Legal Business Name | ALL CARE ONE COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 7300 SANTA FE AVE.
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-7531
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Country | US
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Telephone | 323-277-8900
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Fax | 323-277-8902
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Provider Business Mailing Address
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Address Line | 7300 SANTA FE AVE.
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5731
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Country | US
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Telephone | 323-277-8900
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Fax | 323-277-8902
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL KONONENKO
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Credential |
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Telephone | 323-277-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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