Provider Demographics
NPI:1992981641
Name:LA COMMUNITY OUTREACH CENTER
Entity type:Organization
Organization Name:LA COMMUNITY OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:CLIFF
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:323-755-7800
Mailing Address - Street 1:10121 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3113
Mailing Address - Country:US
Mailing Address - Phone:323-755-7800
Mailing Address - Fax:323-754-3637
Practice Address - Street 1:10121 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3113
Practice Address - Country:US
Practice Address - Phone:323-755-7800
Practice Address - Fax:323-754-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable