Provider Demographics
NPI:1972040467
Name:CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE LEAD
Authorized Official - Prefix:
Authorized Official - First Name:MARICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-724-0019
Mailing Address - Street 1:1000 SAN GABRIEL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4394
Mailing Address - Country:US
Mailing Address - Phone:323-724-0019
Mailing Address - Fax:323-724-3539
Practice Address - Street 1:268 MCARTHUR WAY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5615
Practice Address - Country:US
Practice Address - Phone:323-724-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)