1073828638 NPI number — A HOME FOR US FOUNDATION INCORPORATED

Table of content: (NPI 1073828638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073828638 NPI number — A HOME FOR US FOUNDATION INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A HOME FOR US FOUNDATION INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073828638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3817 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-348-4134
Provider Business Mailing Address Fax Number:
323-292-5543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 11TH AVE
Provider Second Line Business Practice Location Address:
ROOM 106 & 104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90043-4816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-348-4134
Provider Business Practice Location Address Fax Number:
323-292-5543
Provider Enumeration Date:
08/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ADRIANNE
Authorized Official Middle Name:
MARCIA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
323-348-4134

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  190449AN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1437362647 . This is a "DRUG MEDI CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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