1649664491 NPI number — PERSONAL INVOLVEMENT CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649664491 NPI number — PERSONAL INVOLVEMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL INVOLVEMENT CENTER, 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:
1649664491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 514839
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:
90051-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-508-0311
Provider Business Mailing Address Fax Number:
323-778-0485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24404 SOUTH VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-508-0311
Provider Business Practice Location Address Fax Number:
323-778-0485
Provider Enumeration Date:
03/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DIGGS
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
866-508-0311

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)

  • Identifier: 7542A , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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