Provider Demographics
NPI:1174789762
Name:MEDI-CURE HEALTH SERVICES
Entity type:Organization
Organization Name:MEDI-CURE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNIKE-MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-295-1136
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:417
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-295-1136
Mailing Address - Fax:323-295-1071
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:417
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-295-1136
Practice Address - Fax:323-295-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health