Provider Demographics
NPI:1891963393
Name:URDC HUMAN SERVICES CORPORATION
Entity Type:Organization
Organization Name:URDC HUMAN SERVICES CORPORATION
Other - Org Name:BILL MOORE COMMUNITY HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-398-3796
Mailing Address - Street 1:1460 N LAKE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2300
Mailing Address - Country:US
Mailing Address - Phone:626-398-3796
Mailing Address - Fax:626-398-3895
Practice Address - Street 1:1460 N LAKE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2300
Practice Address - Country:US
Practice Address - Phone:626-398-3796
Practice Address - Fax:626-398-3895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URDC HUMAN SERVICES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70645FOtherEAPC