Provider Demographics
NPI:1548610322
Name:H STREET CLINIC
Entity Type:Organization
Organization Name:H STREET CLINIC
Other - Org Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - INGLEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-488-3111
Mailing Address - Street 1:714 W OLYMPIC BLVD STE 801
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1440
Mailing Address - Country:US
Mailing Address - Phone:213-536-5815
Mailing Address - Fax:213-478-0172
Practice Address - Street 1:2710 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2436
Practice Address - Country:US
Practice Address - Phone:323-778-4310
Practice Address - Fax:323-778-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage