MEDICARE: LA COMMUNITY PROJECT, 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	302R00000X	Health Maintenance Organization	NONE YET	CA

General Provider Information

NPI Number	:	1871781179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA COMMUNITY PROJECT, INC.

Provider Business Mailing Address
First Line	:	2104 W MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2721
Country	:	US
Telephone Number	:	323-299-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 W MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2721
Country	:	US
Telephone Number	:	323-299-4666
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. NOBLE DEBAMAKA
Credential	:
Telephone Number	:	323-839-5386

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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Directions to “LA COMMUNITY PROJECT, INC. ” Practice Location

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