Provider Demographics
NPI:1689449571
Name:COMMUNITY MEDICAL WELLNESS CENTERS USA
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL WELLNESS CENTERS USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:628-977-0548
Mailing Address - Street 1:1360 E ANAHEIM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5515
Mailing Address - Country:US
Mailing Address - Phone:562-485-6274
Mailing Address - Fax:
Practice Address - Street 1:1350 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3776
Practice Address - Country:US
Practice Address - Phone:562-485-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)