Provider Demographics
NPI:1255413795
Name:CENTER FOR HEALTH ENHANCEMENT AND
Entity type:Organization
Organization Name:CENTER FOR HEALTH ENHANCEMENT AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-454-0060
Mailing Address - Street 1:881 ALMA REAL DR STE 211
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3748
Mailing Address - Country:US
Mailing Address - Phone:310-454-0060
Mailing Address - Fax:310-454-0065
Practice Address - Street 1:881 ALMA REAL DR STE 211
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3748
Practice Address - Country:US
Practice Address - Phone:310-454-0060
Practice Address - Fax:310-454-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8927261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6719580001Medicare NSC
CAW19252Medicare ID - Type UnspecifiedMEDICARE PROVIDER A#