Provider Demographics
NPI:1750775714
Name:COMMUNITY CENTER FOR HEALTHY MINDS (CCHM)
Entity type:Organization
Organization Name:COMMUNITY CENTER FOR HEALTHY MINDS (CCHM)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOURNOY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-656-6969
Mailing Address - Street 1:13800 HEACOCK ST STE D139B
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-6276
Mailing Address - Country:US
Mailing Address - Phone:951-656-6969
Mailing Address - Fax:951-656-6868
Practice Address - Street 1:13800 HEACOCK ST STE D139B
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6276
Practice Address - Country:US
Practice Address - Phone:951-656-6969
Practice Address - Fax:951-656-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20033302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization