Provider Demographics
NPI:1003820440
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:MIDVALLEY COMPREHENSIVE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-364-3001
Mailing Address - Street 1:7515 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1949
Mailing Address - Country:US
Mailing Address - Phone:818-947-4026
Mailing Address - Fax:
Practice Address - Street 1:7515 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-947-4026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedMV CHC MEDICARE