Provider Demographics
NPI:1801013990
Name:CHACH MEDICAL AID
Entity Type:Organization
Organization Name:CHACH MEDICAL AID
Other - Org Name:CHACH MEDICAL AID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:IDEHEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:310-675-7892
Mailing Address - Street 1:11633 HAWTHORNE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2322
Mailing Address - Country:US
Mailing Address - Phone:310-675-7892
Mailing Address - Fax:
Practice Address - Street 1:11633 HAWTHORNE BLVD STE 215
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2322
Practice Address - Country:US
Practice Address - Phone:310-675-7892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-I0509270844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty