Organization
ANTELOPE VALLEY COMMUNITY CLINIC
Active
Parent organization
ANTELOPE VALLEY COMMUNITY CLINIC
Other names
Antelope Valley Community Clinic - Mobile Health Clinic I
Organization subpart
Yes
Provider details
NPI number
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Authorized official
MR. JAMES A. COOK MSW (CEO)
(661) 942-2391
Entity
Organization
Contact information
Practice address
45104 10TH ST W, LANCASTER, CA 93534-2310
(661) 942-2391
(661) 902-6839
Mailing address
45074 10TH ST W, SUITE 109, LANCASTER, CA 93534-2371
(661) 942-2391
(661) 902-6839
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
060000428
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMM70633H
MEDI-CAL
CA
01
—
CT556A
MEDICARE PTAN
CA
Enumeration date
05/04/2007
Last updated
09/12/2013
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