Basic Information
| Provider Information | |||||||||
| NPI: | 1861673527 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AIDS HEALTHCARE FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 3239628513 | ||||||||
| 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: | 11/21/2007 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3238605348 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AIDS HEALTHCARE FOUNDATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | EAP70454F | 05 | CA | MEDICAID |