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General NPI Number Information
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NPI Number | 1568869709
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Entity Type | Organization
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Legal Business Name | COMMUNITY CLINIC AND HEALTH CARE
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 6715 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3411
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Country | US
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Telephone | 818-601-5878
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3411
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Country | US
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Telephone | 818-601-5878
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIRSTEN WALLACE
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Credential |
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Telephone | 818-651-4594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 538463
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License Number State | CA
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