Provider Demographics
NPI:1912241258
Name:BANJ HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:BANJ HEALTH CENTER, INC.
Other - Org Name:WOMAN AND FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:NERLANDE
Authorized Official - Last Name:LAMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-639-4843
Mailing Address - Street 1:12954 HAWTHORNE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4418
Mailing Address - Country:US
Mailing Address - Phone:424-269-0121
Mailing Address - Fax:424-269-0381
Practice Address - Street 1:12954 HAWTHORNE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4418
Practice Address - Country:US
Practice Address - Phone:424-269-0121
Practice Address - Fax:424-269-0381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANJ HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001116261QA0005X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility