MEDICARE: COMPLETE CARE 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1396380333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	3000 S ROBERTSON BLVD STE 280
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3144
Country	:	US
Telephone Number	:	310-730-6362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE STE 601
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6844
Country	:	US
Telephone Number	:	310-204-0223
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	YURY AKOPYAN
Credential	:
Telephone Number	:	310-730-6362

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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