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General NPI Number Information
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NPI Number | 1801227087
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Entity Type | Organization
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Legal Business Name | CHCADA ROOSEVELT-ISHC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 456 S MATHEWS ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-4326
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Country | US
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Telephone | 323-222-4591
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 21ST STREET
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City | SACRAMENTO
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State | CA
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Zip | 95811
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Country | US
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Telephone | 916-443-5473
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Fax | 916-443-1732
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES HERNANDEZ
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Credential |
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Telephone | 914-443-5473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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