Provider Demographics
NPI:1245210749
Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-454-4481
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:20
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:323-344-4144
Mailing Address - Fax:
Practice Address - Street 1:5059 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1713
Practice Address - Country:US
Practice Address - Phone:323-344-4144
Practice Address - Fax:323-344-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71008FMedicaid
CAFHC71008FMedicaid
CAW16636BMedicare PIN