Provider Demographics
NPI:1093886251
Name:QUEENSCARE HEALTH CENTERS
Entity Type:Organization
Organization Name:QUEENSCARE HEALTH CENTERS
Other - Org Name:QUEENSCARE HEALTH CENTERS - BRESEE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-669-4305
Mailing Address - Street 1:950 S GRAND AVE
Mailing Address - Street 2:2ND FLOOR SOUTH
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4202
Mailing Address - Country:US
Mailing Address - Phone:323-669-4302
Mailing Address - Fax:323-953-6244
Practice Address - Street 1:184 BIMINI PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5903
Practice Address - Country:US
Practice Address - Phone:213-201-6878
Practice Address - Fax:213-201-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000045261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)