Provider Demographics
NPI:1083148753
Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - FONTANA
Entity Type:Organization
Organization Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - FONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:NUSRATH
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:JAHANGIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-234-5000
Mailing Address - Street 1:7965 SIERRA AVE SUITE # E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336
Mailing Address - Country:US
Mailing Address - Phone:909-356-4459
Mailing Address - Fax:909-350-8725
Practice Address - Street 1:714 W. OLYMPIC BLVD SUITE # 801
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015
Practice Address - Country:US
Practice Address - Phone:626-488-3111
Practice Address - Fax:323-206-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)