Provider Demographics
NPI:1558921601
Name:CRENSHAW COMMUNITY CENTER LLC
Entity Type:Organization
Organization Name:CRENSHAW COMMUNITY CENTER LLC
Other - Org Name:CRENSHAW COMMUNITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-604-1778
Mailing Address - Street 1:1060 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1939
Mailing Address - Country:US
Mailing Address - Phone:213-201-7700
Mailing Address - Fax:213-201-7701
Practice Address - Street 1:1060 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1900
Practice Address - Country:US
Practice Address - Phone:213-804-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care