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NPI Code Detail

MEDICARE: HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS

MEDICARE: HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2251X00000XSupports Brokerage Agency
3103TC0700XClinical PsychologistCA

General Provider Information

NPI Number : 1093049546
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Provider Business Mailing Address
First Line : 447 N EL MOLINO AVE
Second Line :
City : PASADENA
State : CA
Zip : 91101-1403
Country : US
Telephone Number : 626-577-8480
Fax Number : 626-577-8978
Provider Business Practice Location Address
First Line : 3600 WILSHIRE BLVD STE 2200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-2632
Country : US
Telephone Number : 213-382-4400
Fax Number : 213-382-4494
Authorized Official
Title or Position : CEO
Name : VATCHE KELARTINIAN
Credential : MBA
Telephone Number : 626-577-8480
Provider Enumeration Date : 09/30/2009
Last Update Date : 02/17/2022

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