Provider Demographics
NPI:1619456928
Name:WHITE MEMORIAL COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:WHITE MEMORIAL COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-987-1222
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 4100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2400
Mailing Address - Country:US
Mailing Address - Phone:323-987-1200
Mailing Address - Fax:323-987-1212
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 4100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2400
Practice Address - Country:US
Practice Address - Phone:323-987-1200
Practice Address - Fax:323-987-1212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE MEMORIAL COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty