MEDICARE: GOODWILL COMMUNITY HEALTH CENTER INC.

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1295131209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL COMMUNITY HEALTH CENTER INC.

Provider Business Mailing Address
First Line	:	2011 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2403
Country	:	US
Telephone Number	:	213-413-4777
Fax Number	:	213-413-4778

Provider Business Practice Location Address
First Line	:	2011 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2403
Country	:	US
Telephone Number	:	213-413-4777
Fax Number	:	213-413-4778

Authorized Official
Title or Position	:	CEO
Name	:	MR. GOR MURADYAN
Credential	:
Telephone Number	:	213-413-4777

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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