1548298532 NPI number — LOS ANGELES LGBT CENTER

Table of content: (NPI 1548298532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548298532 NPI number — LOS ANGELES LGBT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES LGBT CENTER
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:
LOS ANGELES GAY AND LESBIAN COMMUNITY SERVICE CENTER
Provider Other Organization Name Type Code:
4
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:
1548298532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 SCHRADER BLVD
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:
90028-6213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-993-7500
Provider Business Mailing Address Fax Number:
323-308-4015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 SCHRADER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-993-7500
Provider Business Practice Location Address Fax Number:
323-308-4015
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
DARREL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF STAFF
Authorized Official Telephone Number:
323-993-7605

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CMM70532F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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