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NPI Code Detail

MEDICARE: TESSIE CLEVELAND COMMUNITY SERVICES CORPORATION

MEDICARE: TESSIE CLEVELAND COMMUNITY SERVICES CORPORATION
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194850842
Entity Type Code : Organization
Provider Name (Legal Business Name) : TESSIE CLEVELAND COMMUNITY SERVICES CORPORATION
Provider Business Mailing Address
First Line : 8019 S. COMPTON AVENUE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90001-3409
Country : US
Telephone Number : 323-586-7333
Fax Number :
Provider Business Practice Location Address
First Line : 8019 S. COMPTON AVENUE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90001-3409
Country : US
Telephone Number : 323-586-7333
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MRS. CAROLYN CHADWICK
Credential :
Telephone Number : 323-586-7333
Provider Enumeration Date : 02/22/2007
Last Update Date : 10/31/2018

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Directions to “TESSIE CLEVELAND COMMUNITY SERVICES CORPORATION ” Practice Location

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