Provider Demographics
NPI:1245416189
Name:AIDS HEALTHCARE FOUNDATION
Entity Type:Organization
Organization Name:AIDS HEALTHCARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-436-5025
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:833-241-7615
Practice Address - Street 1:6255 W SUNSET BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7403
Practice Address - Country:US
Practice Address - Phone:323-860-5200
Practice Address - Fax:323-962-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70573FMedicaid
CACMM70454FMedicaid
CAGR0049950Medicaid
CACMM70545FMedicaid
CACMM70581FMedicaid
CAGR0049950Medicaid
W11836Medicare PIN
CACMM70573FMedicaid
CACMM70581FMedicaid