Provider Demographics
NPI:1922416411
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:COMMERCE FAMILY MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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:562-776-5014
Mailing Address - Street 1:6513 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1805
Mailing Address - Country:US
Mailing Address - Phone:562-928-9600
Mailing Address - Fax:562-927-8603
Practice Address - Street 1:6001 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2451
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:323-447-1738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QC1500X, 261QF0400X
CA261QF0050X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service