Organization
ANTELOPE VALLEY COMMUNITY CLINIC
Active
Parent organization
ANTELOPE VALLEY COMMUNITY CLINIC
Other names
ANTELOPE VALLEY COMMUNITY CLINIC HEALTH AND WELLNESS CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Authorized official
MR. JAMES A COOK (CEO)
(661) 942-2391
Entity
Organization
Contact information
Practice address
45104 10TH ST W, LANCASTER, CA 93534-2310
(661) 942-2391
(662) 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
550001452
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CT556A
MEDICARE PTAN
CA
Enumeration date
10/07/2010
Last updated
07/06/2011
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