Organization
T.H.E. CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFFORD D SHIEPE MS (INTERIM CHIEF EXECUTIVE OFFICER)
(323) 730-1920
Entity
Organization
Contact information
Practice address
3721 S LA BREA AVE, LOS ANGELES, CA 90016-5309
(323) 730-1920
(213) 742-6785
Mailing address
3834 S WESTERN AVE, LOS ANGELES, CA 90062-1104
(323) 730-1920
(213) 742-6785
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
960001020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9600001020
—
CA
Enumeration date
07/30/2015
Last updated
07/30/2015
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