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Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIK GUPTA CEO (CHIEF EXECUTIVE OFFICER)
(818) 895-3100
Entity
Organization
Contact information
Practice address
10200 SEPULVEDA BLVD STE 300, MISSION HILLS, CA 91345-3321
(818) 830-1441
(818) 221-4114
Mailing address
15206 PARTHENIA ST, NORTH HILLS, CA 91343-5305
(818) 895-3100
(818) 893-9464
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
550000351
CA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
550000351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC70436F
MEDICAL PROVIDER NUMBER
CA
Enumeration date
06/12/2009
Last updated
07/10/2010
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