1093924888 NPI number — THERAPEUTIC LIVING CENTERS FOR THE BLIND, INC.

Table of content: (NPI 1093924888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093924888 NPI number — THERAPEUTIC LIVING CENTERS FOR THE BLIND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC LIVING CENTERS FOR THE BLIND, INC.
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:
1093924888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7915 LINDLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91335-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-708-1740
Provider Business Mailing Address Fax Number:
818-708-7899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23710 COMMUNITY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91304-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-708-1740
Provider Business Practice Location Address Fax Number:
818-708-7899
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEALE
Authorized Official First Name:
FORD
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
818-708-1740

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , 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: 55G513 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC61046F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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