Provider Demographics
NPI:1194871137
Name:COMMUNITY CARE HEALTH CENTERS
Entity type:Organization
Organization Name:COMMUNITY CARE HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-500-0200
Mailing Address - Street 1:8041 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7034
Mailing Address - Country:US
Mailing Address - Phone:714-500-0200
Mailing Address - Fax:714-842-0716
Practice Address - Street 1:1241 W 17TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3459
Practice Address - Country:US
Practice Address - Phone:714-285-9811
Practice Address - Fax:714-285-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000166207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP71134FMedicare ID - Type UnspecifiedCDPEWC
CACMM71134FMedicare ID - Type Unspecified
CAHAP71134FMedicare ID - Type UnspecifiedFAMILY PACT
CAFHC71134FMedicare ID - Type Unspecified