Organization
MISSION CITY COMMUNITY NETWORK,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIK GUPTA CPA (CHEIF 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) 892-3352
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
G23299
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP70436F
—
CA
05
—
FHC70436F
—
CA
05
—
HAP70436F
—
CA
01
—
W11698
GROUP ID
CA
Enumeration date
01/18/2008
Last updated
01/18/2008
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