NPIMap

Organization Active NPI

Mission City Community Network, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hollywood, CA
National Provider Identifier
1710102009
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
960001162 Issued in 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
Last updated
Mar 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 3

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 Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710102009. Details of each certification follow.

  • CCN 551067 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 551067

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MISSION CITY COMMUNITY NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2009
Last certification
Dec 1, 2009
Ownership / control type
For profit – corporation
Facility address
4842 Hollywood Blvd
Los Angeles, CA 90027

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

15201 Eleventh St
Ste 300
Victorville, CA 92395
Phone (760) 245-1640

Practitioners & affiliated clinicians

Practitioners 157

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 157

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1710102009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4842 HOLLYWOOD BLVD",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900275302",
            "telephone_number": "323-644-1110",
            "fax_number": "323-644-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-895-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960001162",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960001162",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "960001162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, CA

Sources for this page

Verify at the official NPI Registry.