Provider Demographics
NPI:1407107667
Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Other - Org Name:CHAPCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BANDA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:626-993-1227
Mailing Address - Street 1:P.O. BOX 948783
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109
Mailing Address - Country:US
Mailing Address - Phone:626-398-6300
Mailing Address - Fax:626-993-1288
Practice Address - Street 1:10408 VACCO ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3328
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-993-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001432261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)