KEDREN COMMUNITY CARE CLINIC-B (NPI# 1295257913) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295257913 |
| Entity Type | Organization |
| Organization Name | KEDREN COMMUNITY CARE CLINIC-B |
| Other Organization Name | KEDREN COMMUNITY CARE CLINIC-B |
| Practice Address |
4211 Avalon Blvd Los Angeles CA 90011-5622 |
| Practice Telephone | (323) 233-0425 |
| Practice Fax Number | 8183377518 |
| Mailing Telephone | 3232330425 |
| Mailing Fax Number | 8183377518 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-07-14 |
| Authorized Official Name | DR. EARLE CHARLES (CHIEF INFORMATION OFFICER) |
| Authorized Official Telephone | 3234325093 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | KEDREN COMMUNITY HEALTH CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Kedren Community Care Clinic-B | Other Name - Individual/Organization |
| Street Address |
4211 AVALON BLVD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90011-5622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316034671 | Sohini Parikh | Psychiatry & Neurology | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2006-10-06 |
| 1427659382 | Dana Thomas | Social Worker | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-11-05 |
| 1487254488 | Destiny Marie Lara | Case Manager/Care Coordinator | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-10-28 |
| 1538767215 | Shira Amiri | Social Worker | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-10-14 |
| 1053927301 | Luz Elena Nunez | Social Worker | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-09-22 |
| 1740895168 | Veronica Isaac | Case Manager/Care Coordinator | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-09-11 |
| 1356952881 | Emily Wakeling | Counselor | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-08-10 |
| 1336758770 | Diana Ramos | Case Manager/Care Coordinator | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-07-30 |
| 1679199632 | Erin Hayden | Counselor | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-06-24 |
| 1861013344 | Katherine Rivas De Ollett | Nurse Practitioner | 4211 Avalon Blvd, Los Angeles, CA 90011-5622 | 2020-05-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184223935 | Commercial & Housing Support Aid | Assisted Living Facility | 120 - 122 East 24th Street, Los Angeles, CA 90011 | 2020-10-22 |
| 1295377711 | Joseph D Madrigal | Home Health Aide | 1977 Anzac Ave, Los Angeles, CA 90011 | 2019-10-16 |
| 1538641212 | Brenda Bahena | Community Health Worker | South Central Family Health Center, 4425 S. Central Ave, Los Angeles, CA 90011 | 2018-08-30 |
| 1083101851 | Bronwyn Anne Hazlewood | Student in an Organized Health Care Education/Training Program | 3740 Maple Ave, 1/2 B, Los Angeles, CA 90011 | 2018-04-17 |
| 1164941183 | Kimberly Denise Lister- Gutierrez | Counselor | 303 E 52nd Street, Los Angeles, CA 90011 | 2017-09-11 |
| 1205252533 | Jameese B Smith | Case Manager/Care Coordinator | 271 E. 43rd Street, Los Angeles, CA 90011 | 2014-03-11 |
| 1033533153 | Avalon-carver Community Center | Community/Behavioral Health | 4920 S. Avalon Blvd, Los Angeles, CA 90011 | 2014-02-10 |
| 1245672500 | Kellie D Bougard | Student in an Organized Health Care Education/Training Program | 4920 South Avalon Blvd, Los Angeles, CA 90011 | 2013-07-26 |
| 1578909404 | Ma. Jasmin F Binas | Nurse Practitioner | 2707 S.central Ave., Los Angeles, CA 90011 | 2013-05-19 |
| 1912343344 | California Assisted Pharmacy, Inc | Pharmacy | 646 E 28th St, Ste #1, Los Angeles, CA 90011 | 2013-05-13 |
| Find all providers in zip 90011 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184224156 | Via Care Community Health Center | Clinic/Center | 400 West Washington Blvd., The Hub D3-room 107, Los Angeles, CA 90015 | 2020-10-29 |
| 1649896903 | Jwch Institute, Inc. | Clinic/Center | 964 N Vermont Ave, Los Angeles, CA 90029-3529 | 2020-06-23 |
| 1306461074 | Jwch Institute, Inc | Clinic/Center | 855 N Vermont Ave, Los Angeles, CA 90029-3516 | 2020-06-09 |
| 1578186144 | Universal Community Health Center | Clinic/Center | 5460 E Beverly Blvd, Los Angeles, CA 90022-2208 | 2020-05-18 |
| 1114556263 | Arm 4 Arm Foundation | Clinic/Center | 231 W Vernon Ave., Suite 101, 201, Los Angeles, CA 90037 | 2020-04-01 |
| 1225673262 | Complete Care Community Health Center, Inc | Clinic/Center | 1300 N Vermont Ave Ste 606, Los Angeles, CA 90027-6088 | 2019-11-13 |
| 1811548712 | Jwch Institute, Inc | Clinic/Center | 1670 E 120 Street, West Support Bldg #14 Fl 2, Los Angeles, CA 90059-3026 | 2019-09-23 |
| 1902453731 | Altamed Health Services Corp | Clinic/Center | 2100 W 3rd St Ste 400, Los Angeles, CA 90057-2290 | 2019-08-26 |
| 1992269757 | Los Angeles Christian Health Centers | Clinic/Center | 325 7th Street, Los Angeles, CA 90014 | 2019-01-25 |
| 1083132849 | Altamed Health Services Corp | Clinic/Center | 2100 W 3rd St Ste 220, Los Angeles, CA 90057-1993 | 2017-08-31 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90011 |
Please comment or provide details below to improve the information on KEDREN COMMUNITY CARE CLINIC-B.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.