Provider Demographics
NPI:1346671989
Name:MANUA HEALTHCARE FOUNDATION, INC
Entity Type:Organization
Organization Name:MANUA HEALTHCARE FOUNDATION, INC
Other - Org Name:MANUA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-853-1230
Mailing Address - Street 1:8033 W SUNSET BLVD # MS 588
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2401
Mailing Address - Country:US
Mailing Address - Phone:323-892-2300
Mailing Address - Fax:310-853-1245
Practice Address - Street 1:6080 CENTER DR FL 6
Practice Address - Street 2:HOWARD HUGHES CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-9205
Practice Address - Country:US
Practice Address - Phone:310-853-1230
Practice Address - Fax:310-853-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207RC0000X, 246X00000X, 282N00000X, 284300000X
CA261QR1100X
AS261QR1100X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS0000000Medicaid
AS0000000000Medicare NSC