Provider Demographics
NPI:1639336803
Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASSETT
Authorized Official - Middle Name:HL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-234-5000
Mailing Address - Street 1:2707 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5527
Mailing Address - Country:US
Mailing Address - Phone:323-234-5000
Mailing Address - Fax:323-231-3985
Practice Address - Street 1:2707 S CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5527
Practice Address - Country:US
Practice Address - Phone:323-234-5000
Practice Address - Fax:323-231-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X, 251X00000X
CA550000352261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639336803Medicaid
CA1639336803Medicaid
CA1639336803Medicare Oscar/Certification