1497809735 NPI number — PHOENIX HOUSES OF LOS ANGELES, INC.

Table of content: (NPI 1497809735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497809735 NPI number — PHOENIX HOUSES OF LOS ANGELES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX HOUSES OF LOS ANGELES, 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:
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:
1497809735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 OCEAN FRONT WALK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90291-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-392-3070
Provider Business Mailing Address Fax Number:
310-392-9068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 OCEAN FRONT WALK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90291-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-392-3070
Provider Business Practice Location Address Fax Number:
310-392-9068
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABBASSI
Authorized Official First Name:
POURIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VICE PRESIDENT, REGIONAL DIRECT
Authorized Official Telephone Number:
818-686-3000

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  190115AN , 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)





Copyright © 2007-2025 www.npivalidator.com