MEDICARE: CITY OF ANGELS 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)

General Provider Information

NPI Number	:	1225498546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ANGELS COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	2417 BEVERLY BLVD
Second Line	:	SUITE 2000
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1001
Country	:	US
Telephone Number	:	626-792-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 BEVERLY BLVD
Second Line	:	SUITE 2000
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1001
Country	:	US
Telephone Number	:	626-792-8400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LARRY A GARCIA
Credential	:
Telephone Number	:	16264857005

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	02/29/2016

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