1790102903 NPI number — NEW DIRECTIONS, INC.

Table of content: (NPI 1790102903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790102903 NPI number — NEW DIRECTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DIRECTIONS, 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:
1790102903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25536
Provider Second Line Business Mailing Address:
14420 SANTA MONICA BOULEVARD
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-0536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-914-4045
Provider Business Mailing Address Fax Number:
310-914-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11303 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
VA BUILDING 116
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-5069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-914-4045
Provider Business Practice Location Address Fax Number:
310-914-5495
Provider Enumeration Date:
03/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
310-914-4045

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 190209AN , 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: 1790102903 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com