05D2081416 CLIA NUMBER - CENTRAL CITY COMMUNITY HEALTH CENTER, INC

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Laboratory Demographics

CLIA Number: 05D2081416

Facility Name: CENTRAL CITY COMMUNITY HEALTH CENTER, INC

Facility Address:
4160 N MAINE AVE STE B1, B2,B3
BALDWIN PARK, CA
ZIP 91706
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Facility Phone Number: 626 384-2400

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1558770818

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2081416
LAB Type	Federally Qualified Health Center
Facility Name	CENTRAL CITY COMMUNITY HEALTH CENTER, INC
Street	4160 N MAINE AVE STE B1, B2,B3
City	BALDWIN PARK
State	CA
ZIP	91706
Phone	626 384-2400
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024