MEDICARE: KEDREN COMMUNITY MENTAL HEALTH CENTER

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	930000028	CA

General Provider Information

NPI Number	:	1134336811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEDREN COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	4211 AVALON BLVD
Second Line	:	HR DEPARTMENT
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-5622
Country	:	US
Telephone Number	:	323-582-2251
Fax Number	:	323-582-2251

Provider Business Practice Location Address
First Line	:	918 E 60TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1017
Country	:	US
Telephone Number	:	323-802-0264
Fax Number	:	323-802-0264

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	HILDA RODRIGUEZ
Credential	:
Telephone Number	:	323-802-0264

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/10/2026

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