Provider Demographics
NPI:1417211426
Name:POMONA COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:POMONA COMMUNITY HEALTH CENTER
Other - Org Name:POMONA COMMUNITY HEALTH CENTER - VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-630-7939
Mailing Address - Street 1:1450 E HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5822
Mailing Address - Country:US
Mailing Address - Phone:909-630-7927
Mailing Address - Fax:909-620-6719
Practice Address - Street 1:1450 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5822
Practice Address - Country:US
Practice Address - Phone:909-630-7927
Practice Address - Fax:909-620-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538486741OtherNPPES