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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