Provider Demographics
NPI:1669813515
Name:ELDORADO COMMUNITY SERVICE CENTER
Entity Type:Organization
Organization Name:ELDORADO COMMUNITY SERVICE CENTER
Other - Org Name:LIFELINE MEDICAL AND MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEANJAY
Authorized Official - Middle Name:RAMANAND
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-6630
Mailing Address - Street 1:5200 SAN GABRIEL PL
Mailing Address - Street 2:STE D
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2497
Mailing Address - Country:US
Mailing Address - Phone:562-222-1310
Mailing Address - Fax:562-222-2301
Practice Address - Street 1:9442/9500 INTERNATIONAL BLVD.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-1444
Practice Address - Country:US
Practice Address - Phone:510-777-8448
Practice Address - Fax:510-777-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care