Provider Demographics
NPI:1407230899
Name:CENTRAL CITY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:CENTRAL CITY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-724-0019
Mailing Address - Street 1:2019 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7415
Mailing Address - Country:US
Mailing Address - Phone:323-724-0019
Mailing Address - Fax:323-248-7044
Practice Address - Street 1:2243 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-490-2750
Practice Address - Fax:714-490-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)