Provider Demographics
NPI:1215293733
Name:QUEENSCARE HEALTH ALLIANCE
Entity type:Organization
Organization Name:QUEENSCARE HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-669-4302
Mailing Address - Street 1:950 S GRAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3999
Mailing Address - Country:US
Mailing Address - Phone:323-669-4346
Mailing Address - Fax:323-953-2757
Practice Address - Street 1:680 LITTLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1644
Practice Address - Country:US
Practice Address - Phone:237-151-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEENSCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty