Provider Demographics
NPI:1043861966
Name:HOPE COMMUNITY CARE CLINIC, INC.
Entity Type:Organization
Organization Name:HOPE COMMUNITY CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMVALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-243-9999
Mailing Address - Street 1:716 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1010
Mailing Address - Country:US
Mailing Address - Phone:818-243-9999
Mailing Address - Fax:
Practice Address - Street 1:716 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1010
Practice Address - Country:US
Practice Address - Phone:818-243-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE COMMUNITY CARE CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-23
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty