Provider Demographics
NPI:1386824688
Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS
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:818-265-2210
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:818-265-2210
Mailing Address - Fax:818-291-0291
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#20
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2210
Practice Address - Fax:818-291-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty