Provider Demographics
NPI:1659597037
Name:RUSSIAN JEWISH COMMUNITY CULTURAL CENTER
Entity Type:Organization
Organization Name:RUSSIAN JEWISH COMMUNITY CULTURAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:NAFTOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-650-8118
Mailing Address - Street 1:7636 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-650-8118
Mailing Address - Fax:323-650-8504
Practice Address - Street 1:7636 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:323-650-8118
Practice Address - Fax:323-650-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70289FMedicaid