MEDICARE: URDC HUMAN SERVICES CORPORATION

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	261QC1500X	Community Health Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EAP70645F	OTHER	CA	EAPC

General Provider Information

NPI Number	:	1891963393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URDC HUMAN SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	1460 N LAKE AVE
Second Line	:	SUITE 107
City	:	PASADENA
State	:	CA
Zip	:	91104-2300
Country	:	US
Telephone Number	:	626-398-3796
Fax Number	:	626-398-3895

Provider Business Practice Location Address
First Line	:	1460 N LAKE AVE
Second Line	:	SUITE 107
City	:	PASADENA
State	:	CA
Zip	:	91104-2300
Country	:	US
Telephone Number	:	626-398-3796
Fax Number	:	626-398-3895

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. AL SORKIN
Credential	:	PH.D.
Telephone Number	:	626-398-3796

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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Directions to “URDC HUMAN SERVICES CORPORATION ” Practice Location

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