Provider Demographics
NPI:1730454901
Name:FCBC COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:FCBC COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:310-330-8000
Mailing Address - Street 1:333 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1103
Mailing Address - Country:US
Mailing Address - Phone:310-330-8000
Mailing Address - Fax:310-419-0041
Practice Address - Street 1:333 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1103
Practice Address - Country:US
Practice Address - Phone:310-330-8000
Practice Address - Fax:310-419-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health