Provider Demographics
NPI:1417251687
Name:MEDI CURE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MEDI CURE HEALTH SERVICES, INC
Other - Org Name:MANUAL ARTS HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXEC. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANNIKE-MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:323-295-1136
Mailing Address - Street 1:3756 SANTA ROSALIA DR STE 417
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3614
Mailing Address - Country:US
Mailing Address - Phone:323-295-1136
Mailing Address - Fax:323-295-1071
Practice Address - Street 1:4131 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1918
Practice Address - Country:US
Practice Address - Phone:323-839-9067
Practice Address - Fax:323-295-1071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDI CURE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190636AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health