Basic Information
| Provider Information | |||||||||
| NPI: | 1043777089 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNICARE COMMUNITY HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 437 N EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097491835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5549 VAN BUREN BLVD | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925032068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513245901 | ||||||||
| FaxNumber: | 9513591025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2019 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | MACHKALYAN | ||||||||
| AuthorizedOfficialFirstName: | AVETIK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9099882555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.