Provider Demographics
NPI:1811032436
Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Other - Org Name:HAWAIIAN GARDENS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-928-9600
Mailing Address - Street 1:22310 WARDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1740
Mailing Address - Country:US
Mailing Address - Phone:562-420-2433
Mailing Address - Fax:562-429-2053
Practice Address - Street 1:22310 WARDHAM AVE
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1740
Practice Address - Country:US
Practice Address - Phone:562-420-2433
Practice Address - Fax:562-429-2053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001120261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70824FMedicaid