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NPI Code Detail

MEDICARE: EL CENTRO DE AMISTAD, INC.

MEDICARE: EL CENTRO DE AMISTAD, 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1831215383
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL CENTRO DE AMISTAD, INC.
Provider Business Mailing Address
First Line : 7038 OWENSMOUTH AVE
Second Line :
City : CANOGA PARK
State : CA
Zip : 91303-3198
Country : US
Telephone Number : 818-347-8565
Fax Number : 818-347-0506
Provider Business Practice Location Address
First Line : 7038 OWENSMOUTH AVE
Second Line :
City : CANOGA PARK
State : CA
Zip : 91303-3198
Country : US
Telephone Number : 818-347-8565
Fax Number : 818-347-0506
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. TAMIKA LATASHA FARR
Credential : MBA
Telephone Number : 818-898-0223
Provider Enumeration Date : 03/22/2007
Last Update Date : 04/09/2014

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