Provider Demographics
NPI:1457428252
Name:COMPTON MENTAL HEALTH FSP
Entity Type:Organization
Organization Name:COMPTON MENTAL HEALTH FSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNIEHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-885-2108
Mailing Address - Street 1:2137 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2137 5TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1166
Practice Address - Country:US
Practice Address - Phone:310-668-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit