Provider Demographics
NPI:1093041162
Name:AFRIKAN CHRISTIAN CENTER, INC
Entity Type:Organization
Organization Name:AFRIKAN CHRISTIAN CENTER, INC
Other - Org Name:NOBLE REHAB CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-770-2519
Mailing Address - Street 1:1818 S WESTERN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5862
Mailing Address - Country:US
Mailing Address - Phone:310-770-2519
Mailing Address - Fax:
Practice Address - Street 1:1818 S WESTERN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5862
Practice Address - Country:US
Practice Address - Phone:310-770-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197179251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197179OtherMEDICAL PROVIDER #