Provider Demographics
NPI:1376913400
Name:THE CAMDEN CENTER OLDER ADULTS PROGRAM, INC.
Entity Type:Organization
Organization Name:THE CAMDEN CENTER OLDER ADULTS PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-422-6336
Mailing Address - Street 1:10780 SANTA MONICA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7613
Mailing Address - Country:US
Mailing Address - Phone:844-422-6336
Mailing Address - Fax:888-887-2955
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7613
Practice Address - Country:US
Practice Address - Phone:844-422-6336
Practice Address - Fax:888-887-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB4021549103TA0700X
CAA1125382084P0800X
CA397122084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty