Provider Demographics
NPI:1508073685
Name:SHARE OUR SELVES CORPORATION
Entity Type:Organization
Organization Name:SHARE OUR SELVES CORPORATION
Other - Org Name:SHARE OUR SELVES COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-536-3927
Mailing Address - Street 1:PO BOX 10159
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0050
Mailing Address - Country:US
Mailing Address - Phone:949-270-2100
Mailing Address - Fax:949-515-5804
Practice Address - Street 1:1550 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3653
Practice Address - Country:US
Practice Address - Phone:949-270-2100
Practice Address - Fax:949-515-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70513FOtherMEDI-CAL
CA751028Medicare Oscar/Certification
CAFH413AMedicare UPIN