Provider Demographics
NPI:1871689315
Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Other - Org Name:CHAPCARE-FAIR OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BANDA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:626-993-1227
Mailing Address - Street 1:455 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1327
Mailing Address - Country:US
Mailing Address - Phone:626-993-1212
Mailing Address - Fax:626-993-1288
Practice Address - Street 1:1855 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-398-5948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH ALLIANCE OF PASADENA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001053261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA97256AMedicare PIN
CA5031707OtherHEALTHCARE L.A.
CAEAP70768FMedicaid
CAWPA17745AMedicare PIN
CAFHC70768FMedicaid
CA31146-0001Medicare UPIN
OTH000Medicare UPIN
CACMM70768FMedicaid
WA77900AMedicare PIN
WA76188AMedicare PIN
CAG92160Medicaid
CA=========OtherMETLIFE PREFERRED DENTAL
CA=========OtherPPP
CAWA54044DMedicare PIN
CAWPA18520AMedicare PIN
H79394Medicare UPIN
CAW14338Medicare ID - Type UnspecifiedMEDICARE
CAHAP70768FMedicaid