Provider Demographics
NPI:1437482635
Name:KEDREN MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:KEDREN MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEDREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:323-733-3886
Mailing Address - Street 1:8927 RAMSGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4611
Mailing Address - Country:US
Mailing Address - Phone:310-686-5473
Mailing Address - Fax:
Practice Address - Street 1:2160 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2039
Practice Address - Country:US
Practice Address - Phone:323-733-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0011542699Medicaid