Provider Demographics
NPI:1952650228
Name:INTEGRATED COMMUNITY HEALTHCARE SOLUTIONS
Entity Type:Organization
Organization Name:INTEGRATED COMMUNITY HEALTHCARE SOLUTIONS
Other - Org Name:BUENA PARK COMMUNITY CLINIC - BP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-880-9010
Mailing Address - Street 1:8332 COMMONWEALTH AVE # B
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2526
Mailing Address - Country:US
Mailing Address - Phone:714-880-9010
Mailing Address - Fax:855-204-8717
Practice Address - Street 1:8332 COMMONWEALTH AVE # B
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2526
Practice Address - Country:US
Practice Address - Phone:714-880-9010
Practice Address - Fax:855-204-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10055Medicaid