Provider Demographics
NPI:1134593999
Name:LONG BEACH FAMILY HEALTH CARE SERVICES I NC.
Entity type:Organization
Organization Name:LONG BEACH FAMILY HEALTH CARE SERVICES I NC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:FOREMAN FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-210-5175
Mailing Address - Street 1:970 SUNNYHILL PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4600
Mailing Address - Country:US
Mailing Address - Phone:909-210-5175
Mailing Address - Fax:
Practice Address - Street 1:2385 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3025
Practice Address - Country:US
Practice Address - Phone:562-336-1400
Practice Address - Fax:562-336-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNK261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care