Provider Demographics
NPI:1699303628
Name:TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity type:Organization
Organization Name:TRI-STATE COMMUNITY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-297-0884
Mailing Address - Street 1:4141 1/2 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3820
Mailing Address - Country:US
Mailing Address - Phone:323-297-0884
Mailing Address - Fax:323-274-4604
Practice Address - Street 1:4137 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3820
Practice Address - Country:US
Practice Address - Phone:323-344-9255
Practice Address - Fax:323-344-8776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-STATE COMMUNITY HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)