Provider Demographics
NPI:1811279763
Name:BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-466-3895
Mailing Address - Street 1:43322 GINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4576
Mailing Address - Country:US
Mailing Address - Phone:661-874-4050
Mailing Address - Fax:661-942-3500
Practice Address - Street 1:43322 GINGHAM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4576
Practice Address - Country:US
Practice Address - Phone:661-874-4050
Practice Address - Fax:661-942-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2015040Medicaid
CA2015040Medicaid
CA551182Medicare Oscar/Certification