Basic Information
| Provider Information | |||||||||
| NPI: | 1649614843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEDREN COMMUNITY MENTAL HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4211 AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900115622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232330425 | ||||||||
| FaxNumber: | 3234325086 | ||||||||
| Practice Location | |||||||||
| Address1: | 3761 STOCKER ST STE 211 | ||||||||
| Address2: | |||||||||
| City: | VIEW PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900085129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232330425 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2013 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFITH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT-CEO | ||||||||
| AuthorizedOfficialTelephone: | 3232330425 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KEDREN COMMUNITY MENTAL HEALTH CENTER INC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 930000028 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.