Provider Demographics
NPI:1316039241
Name:ELDORADO COMMUNITY SERVICE CENTER
Entity Type:Organization
Organization Name:ELDORADO COMMUNITY SERVICE CENTER
Other - Org Name:EL DORADO-LAWNDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRAMESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-313-5503
Mailing Address - Street 1:26460 SUMMIT CIRCLE (CORPORATE OFFICE)
Mailing Address - Street 2:SANTA CLARITA
Mailing Address - City:CALIFORNIA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1809
Mailing Address - Country:US
Mailing Address - Phone:661-254-6630
Mailing Address - Fax:
Practice Address - Street 1:4023 MARINE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1840
Practice Address - Country:US
Practice Address - Phone:310-675-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
CA960000924261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70643FMedicaid
CACMM70643FMedicaid