MISSION CITY COMMUNITY NETWORK, INC. (NPI# 1790133379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790133379 |
| Entity Type | Organization |
| Organization Name | MISSION CITY COMMUNITY NETWORK, INC. |
| Practice Address |
405 E Buena Vista St Barstow CA 92311-2815 |
| Mailing Address |
15206 Parthenia St North Hills CA 91343-5305 |
| Practice Telephone | 8188953100 |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2018-09-17 |
| Authorized Official Name | NIK GUPTA (CEO) |
| Authorized Official Telephone | 8188953100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992246979 | Mission City Community Network, Inc. | Clinic/Center | 2655 W. Olympic Blvd., Los Angeles, CA 90006-2810 | 2017-03-10 |
| 1174971741 | Mission City Community Network, Inc. | Clinic/Center | 359 N Fairfax Ave, Los Angeles, CA 90036-2179 | 2016-05-24 |
| 1043593304 | Mission City Community Network, Inc. | Clinic/Center | 15210 Parthenia St., North Hills, CA 91343 | 2011-09-23 |
| 1275786402 | Mission City Community Network, Inc. | Clinic/Center | 8363 Reseda Blvd Ste 11, Northridge, CA 91324-4694 | 2008-10-31 |
| 1306017603 | Mission City Community Network, Inc. | Clinic/Center | 9919 Laurel Canyon Blvd, Pacoima, CA 91331-3940 | 2008-03-14 |
| 1760409791 | Mission City Community Network, Inc. | Clinic/Center | 15206 Parthenia St, North Hills, CA 91343-5305 | 2006-07-16 |
| 1063039469 | Mission City Community Network, Inc. | Clinic/Center | 3220 N Bronco St, Las Vegas, NV 89108-4862 | 2020-07-01 |
| 1780199307 | Mission City Community Network, Inc. | Clinic/Center | 222 W Eulalia St Ste 301, Glendale, CA 91204-2851 | 2017-12-05 |
| 1083062343 | Mission City Community Network, Inc. | Clinic/Center | 9919 Laurel Canyon Blvd, Pacoima, CA 91331-3940 | 2016-05-27 |
| 1528416104 | Mission City Community Network, Inc. | Clinic/Center | 9808 Venice Blvd, Culver City, CA 90232-2732 | 2016-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MISSION CITY COMMUNITY NETWORK, INC. | 15206/15210 Parthenia St, North Hills, CA 91343 |
| Street Address |
405 E BUENA VISTA ST |
| City | BARSTOW |
| State | CA |
| Zip Code | 92311-2815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528552437 | Sheri Lorena Brady | Counselor | 309 E. Mt. View Suite 100, Barstow, CA 92311 | 2018-06-15 |
| 1205352556 | Julie Ann Pellman | Dietitian, Registered | 100 Veterans Parkway, Barstow, CA 92311 | 2017-08-18 |
| 1821511106 | Ambria Nicole Flippo | Counselor | 309 E Mountain View, Suite 100, Barstow, CA 92311 | 2017-07-19 |
| 1124485289 | Wellness Acupuncture Clinic | Case Management | 1866 E Main St, Barstow, CA 92311 | 2016-01-20 |
| 1346606407 | Kirsten Cheong | Counselor | 306 E. Mountain View St., Suite 100, Barstow, CA 92311 | 2016-01-05 |
| 1205222536 | American Health Services LLC | Substance Abuse Rehabilitation Facility | 234/236, 300, 304 and 308e Fredricks Street, Barstow, CA 92311 | 2015-04-14 |
| 1043629512 | Jon Pellerin | Pharmacist | 621 Montara, Barstow, CA 92311 | 2014-08-08 |
| 1255777421 | Ramendeep K Singh | Family Medicine | 1890 W. Main St., Suite 110, Barstow, CA 92311 | 2013-05-15 |
| 1760731061 | Jenifer Kristine Cordova | Physical Therapist | 1815 E. Main St., Barstow, CA 92311 | 2012-08-31 |
| 1053697250 | Lisa Herrmann | Counselor | 222 E Main St. Suite 117, Barstow, CA 92311 | 2011-11-01 |
| Find all providers in zip 92311 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.