| Maclay Wellness Center | |
|
12451 W. Gain Street Pacoima CA 91331 | |
| (818) 897-2193 | |
| (818) 890-2394 |
| Full Name | Maclay Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12451 W. Gain Street, Pacoima, California |
| Authorized Official Name and Position | Kimberly Wyard (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8188981388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maclay Wellness Center 1172 N Maclay Ave San Fernando CA 91340-1328 Ph: (818) 898-1388 | Maclay Wellness Center 12451 W. Gain Street Pacoima CA 91331 Ph: (818) 897-2193 |
| NPI Number | 1053312587 |
|---|---|
| Provider Enumeration Date | 08/09/2005 |
| Last Update Date | 02/22/2022 |
| Certification Date | 02/22/2022 |
| Medicare PECOS PAC ID | 3173517323 |
|---|---|
| Medicare Enrollment ID | O20201221001438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053312587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| 171M00000X | Case Manager/care Coordinator | () | Secondary |
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