Provider Demographics
NPI:1841412962
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:CHS - CENTURY REGIONAL DETENTION FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-893-5304
Mailing Address - Street 1:1000 S. FREMONT. AVE., UNIT #9
Mailing Address - Street 2:BLDG A11, GROUND FL, SUITE A11010
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8801
Mailing Address - Country:US
Mailing Address - Phone:626-525-6076
Mailing Address - Fax:
Practice Address - Street 1:11705 S. ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4023
Practice Address - Country:US
Practice Address - Phone:323-568-4555
Practice Address - Fax:323-415-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCF474613336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5628334OtherNCPDP PROVIDER IDENTIFICATION NUMBER