Provider Demographics
NPI:1194265637
Name:CENTRAL CITY COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:CENTRAL CITY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-724-0019
Mailing Address - Street 1:2019 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7415
Mailing Address - Country:US
Mailing Address - Phone:323-724-0019
Mailing Address - Fax:
Practice Address - Street 1:5715 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:213-471-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551083Medicare PIN