Community Residential Care Program

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

483652 Issued in CA

Legal business name

COMMUNITY RESIDENTIAL CARE PROGRAM

Practice address

1416 W 103Rd St
Los Angeles, CA 90047-4510

Phone

(323) 777-0269

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Denise Marie Polk

Title

Registered Nurse

Phone

(310) 478-3711

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871691352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 W 103RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900474510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 W 103RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900474510",
            "telephone_number": "323-777-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESIDENTIAL CARE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "310-478-3711",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "483652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Healthcare Resources Inc.
• Community Laboratory Inc
• Community Outreach for a Brighter California
• Community Partners
• Community Reflections Inc
• Community Resources United Sharing Hope Inc.
• Community Solutions in-Home Care
• Community Support Clinic, Inc.
• Community West LLC
• Communy Care at Home

• General Acute Care Hospital in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Acute Care Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.