Provider Demographics
NPI:1659837946
Name:BLYTHE COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:BLYTHE COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-905-6065
Mailing Address - Street 1:3218 E HOLT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2310
Mailing Address - Country:US
Mailing Address - Phone:714-905-6065
Mailing Address - Fax:
Practice Address - Street 1:3218 E HOLT AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-2310
Practice Address - Country:US
Practice Address - Phone:714-905-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)