Provider Demographics
NPI:1710699483
Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-630-6106
Mailing Address - Street 1:801 S. CHEVY CHASE DR. #20
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:818-630-6101
Mailing Address - Fax:818-844-5085
Practice Address - Street 1:8316 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040
Practice Address - Country:US
Practice Address - Phone:818-273-8929
Practice Address - Fax:818-844-5090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE COMMUNITY HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty