1033248133 NPI number — HOMES FOR LIFE FOUNDATION

Table of content: (NPI 1033248133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033248133 NPI number — HOMES FOR LIFE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMES FOR LIFE FOUNDATION
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:
6
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:
1033248133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8939 S SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 460
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-337-7417
Provider Business Mailing Address Fax Number:
310-337-7413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 E FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91776-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-337-7417
Provider Business Practice Location Address Fax Number:
310-337-7413
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIESS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
310-337-7417

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7506A . This is a "LOS ANGELES COUNTY DMH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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