Provider Demographics
NPI:1669088464
Name:BETHEL LOS ANGELES COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:BETHEL LOS ANGELES COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-206-1988
Mailing Address - Street 1:7900 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2715
Mailing Address - Country:US
Mailing Address - Phone:323-206-1988
Mailing Address - Fax:
Practice Address - Street 1:7900 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2715
Practice Address - Country:US
Practice Address - Phone:323-206-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty