Provider Demographics
NPI:1386874840
Name:HERD COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:HERD COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-7249
Mailing Address - Street 1:PO BOX 881329
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-7329
Mailing Address - Country:US
Mailing Address - Phone:310-641-0870
Mailing Address - Fax:310-641-8476
Practice Address - Street 1:6820 LA TIJERA BLVD
Practice Address - Street 2:STE. 217
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1908
Practice Address - Country:US
Practice Address - Phone:310-568-0244
Practice Address - Fax:310-568-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health