1073643292 NPI number — HAMBURGER HOME

Table of content: (NPI 1073643292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073643292 NPI number — HAMBURGER HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMBURGER HOME
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:
AVIVA FAMILY AND CHILDREN'S SERVICES
Provider Other Organization Name Type Code:
3
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:
1073643292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3580 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
STE 800
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-876-0550
Provider Business Mailing Address Fax Number:
213-637-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5805 SEPULVEDA BLVD STE 710
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91411-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-980-3200
Provider Business Practice Location Address Fax Number:
818-980-3203
Provider Enumeration Date:
03/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LABBE
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PROGRAMS & SERVICES
Authorized Official Telephone Number:
323-876-0550

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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