Provider Demographics
NPI:1063748242
Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Entity type:Organization
Organization Name:COMMUNITY HEALTH ALLIANCE OF PASADENA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-993-1238
Mailing Address - Street 1:455 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1327
Mailing Address - Country:US
Mailing Address - Phone:626-993-1212
Mailing Address - Fax:626-993-1288
Practice Address - Street 1:1595 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2307
Practice Address - Country:US
Practice Address - Phone:626-993-1262
Practice Address - Fax:626-486-9656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH ALLIANCE OF PASADENA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-23
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001311261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH79394Medicare UPIN
CAW14338Medicare PIN
CAEAP70768FOtherEAPC
CAHAP70768FOtherFAMPACT
CA1871689315Medicaid