Organization
CHCADA ROOSEVELT-ISHC
Active
Organization
CHCADA ROOSEVELT-ISHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES HERNANDEZ (EXECUTIVE DIRECTOR)
(914) 443-5473
Entity
Organization
Contact information
Practice address
456 S MATHEWS ST, LOS ANGELES, CA 90033-4326
(323) 222-4591
Mailing address
1419 21ST STREET, SACRAMENTO, CA 95811
(916) 443-5473
(916) 443-1732
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7884
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
12/12/2013
Last updated
11/20/2015
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