Provider Demographics
NPI:1972365237
Name:CHISAN HEALTHCARE SERVICES CORP
Entity Type:Organization
Organization Name:CHISAN HEALTHCARE SERVICES CORP
Other - Org Name:CHISAN HEALTHCARE CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CHINENYE
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:323-347-9220
Mailing Address - Street 1:8803 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305
Mailing Address - Country:US
Mailing Address - Phone:323-347-9220
Mailing Address - Fax:
Practice Address - Street 1:8803 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:323-347-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)