| Locke Wellness Center | |
|
316 E 111th St Los Angeles CA 90061-3004 | |
| (323) 568-3093 | |
| Not Available |
| Full Name | Locke Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 316 E 111th St, Los Angeles, California |
| Authorized Official Name and Position | David Brumlage (ASSISTANT CONTROLLER) |
| Authorized Official Contact | 3235644331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Locke Wellness Center 10300 Compton Ave Los Angeles CA 90002-3628 Ph: (323) 357-6680 | Locke Wellness Center 316 E 111th St Los Angeles CA 90061-3004 Ph: (323) 568-3093 |
| NPI Number | 1104246362 |
|---|---|
| Provider Enumeration Date | 04/25/2014 |
| Last Update Date | 05/23/2023 |
| Medicare PECOS PAC ID | 0446161533 |
|---|---|
| Medicare Enrollment ID | O20230608000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104246362 | NPI | - | NPPES |
| 1104246362 | Medicaid | CA | |
| 1477649119 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550002583 (California) | Primary |
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