Provider Demographics
NPI: | 1457116709 |
---|---|
Name: | H STREET CLINIC |
Entity Type: | Organization |
Organization Name: | H STREET CLINIC |
Other - Org Name: | CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - WILSHIRE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CAO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELEANOR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PEREZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 909-381-0803 |
Mailing Address - Street 1: | 2700 S GRAND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90007-3301 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 213-536-5814 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1245 WILSHIRE BLVD STE 715 |
Practice Address - Street 2: | |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90017-4807 |
Practice Address - Country: | US |
Practice Address - Phone: | 213-643-3170 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | H STREET CLINIC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2024-02-15 |
Last Update Date: | 2024-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |