Provider Demographics
NPI:1720115033
Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC
Other - Org Name:BELL GARDENS FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-928-9600
Mailing Address - Street 1:6001 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2451
Mailing Address - Country:US
Mailing Address - Phone:562-928-9600
Mailing Address - Fax:562-927-6974
Practice Address - Street 1:6501 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1805
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:562-927-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000881261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70574FMedicaid
CABU386AOtherGROUP PTAN