Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIK GUPTA (CHIEF EXECUTIVE OFFICER)
(818) 895-3100
Entity
Organization
Contact information
Practice address
4842 HOLLYWOOD BLVD, HOLLYWOOD, CA 90027-5302
(323) 644-1110
(323) 644-1171
Mailing address
15206 PARTHENIA ST, NORTH HILLS, CA 91343-5305
(818) 895-3100
(818) 892-3352
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
960001162
CA
261QF0400X
Federally Qualified Health Center (FQHC)
960001162
CA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
960001162
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
551067
MEDICARE FQHC
CA
01
—
FHC70938F
MEDICAL PROVIDER NUMBER
CA
05
—
HAP70436F
—
CA
Enumeration date
04/13/2007
Last updated
03/21/2011
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