Basic Information
| Provider Information | |||||||||
| NPI: | 1245416189 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AIDS HEALTHCARE FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 8332417615 | ||||||||
| Practice Location | |||||||||
| Address1: | 6255 W SUNSET BLVD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 3239628513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | STIDHAM | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3234365025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | CMM70573F | 05 | CA | MEDICAID | CMM70454F | 05 | CA | MEDICAID | GR0049950 | 05 | CA | MEDICAID | CMM70545F | 05 | CA | MEDICAID | CMM70581F | 05 | CA | MEDICAID |