NPIMap

Mission City Community Network, Inc.

Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Hollywood, CA

NPI 1710102009 · NPPES record last updated Mar 21, 2011

Key facts

NPI
1710102009
Entity type
Organization (NPI type 2)
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
License
960001162 (CA)
Legal business name
MISSION CITY COMMUNITY NETWORK, INC.
Practice address
4842 Hollywood Blvd
Hollywood, CA 90027-5302
Phone
(323) 644-1110
Fax
(323) 644-1171
NPI assigned
Apr 13, 2007
Organization subpart
No

Authorized official

Name
Mr. Nik Gupta
Title
Chief Executive Officer
Phone
(818) 895-3100

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 18

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 158

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 158

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040204000544 CA Part B Supplier - Clinic/Group Practice 1658264684 Receives reassigned benefits from 152 practitioners
8 other NPIs on this enrollment
Practice locations: North Hills, CA; Northridge, CA; Victorville, CA

National Provider Directory

Locations

4842 Hollywood Blvd
Los Angeles, CA 90027
Phone (323) 644-1110

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 960001162 CA
Federally Qualified Health Center (FQHC) 261QF0400X 960001162 CA
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 960001162 CA Yes

Addresses

Primary practice location

4842 Hollywood Blvd
Hollywood, CA 90027-5302

Mailing address

15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100

Other identifiers

IdentifierTypeStateIssuer
FHC70938FOtherCAMEDICAL PROVIDER NUMBER
HAP70436FMedicaidCA
551067OtherCAMEDICARE FQHC

Other providers in Hollywood, CA

All providers in Hollywood, CA · Mental Health Clinic/Center (Including Community Mental Health Center) in California

Sources for this page

Verify at the official NPI Registry.