Provider Demographics
NPI:1518036565
Name:BANJ HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:BANJ HEALTH CENTER, INC.
Other - Org Name:COMPTON CENTRAL HEALTH CLINIC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-639-4843
Mailing Address - Street 1:201 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1425
Mailing Address - Country:US
Mailing Address - Phone:310-635-7123
Mailing Address - Fax:310-635-0535
Practice Address - Street 1:201 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1425
Practice Address - Country:US
Practice Address - Phone:310-635-7123
Practice Address - Fax:310-635-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001116261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14799Medicare ID - Type Unspecified