Provider Demographics
NPI:1982935565
Name:CALIFORNIA MENTAL HEALTH CONNECTION
Entity Type:Organization
Organization Name:CALIFORNIA MENTAL HEALTH CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAKIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:626-203-1449
Mailing Address - Street 1:714 N SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-1227
Mailing Address - Country:US
Mailing Address - Phone:626-430-0474
Mailing Address - Fax:626-430-0474
Practice Address - Street 1:2217 CALLE PARRAL
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2182
Practice Address - Country:US
Practice Address - Phone:626-430-0474
Practice Address - Fax:626-430-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198601281261QM0801X, 261QM0850X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health