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
1	171M00000X	Case Manager/Care Coordinator
2	251X00000X	Supports Brokerage Agency
3	103TC0700X	Clinical Psychologist	2255549	CA

General Provider Information

NPI Number	:	1306899091
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	:	253 N SAN GABRIEL BLVD STE 100
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3429
Country	:	US
Telephone Number	:	626-577-8480
Fax Number	:	626-577-8978

Authorized Official
Title or Position	:	CEO
Name	:	MR. VATCHE KELARTINIAN
Credential	:	MBA
Telephone Number	:	626-577-8480

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/22/2024

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