Provider Demographics
NPI:1871781179
Name:LA COMMUNITY PROJECT, INC.
Entity type:Organization
Organization Name:LA COMMUNITY PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBAMAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-839-5386
Mailing Address - Street 1:2104 W MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2721
Mailing Address - Country:US
Mailing Address - Phone:323-299-4666
Mailing Address - Fax:
Practice Address - Street 1:2104 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2721
Practice Address - Country:US
Practice Address - Phone:323-299-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE YET302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization