MEDICARE: GRAB THE WHEEL KIDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1114495801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAB THE WHEEL KIDS

Provider Business Mailing Address
First Line	:	2300 WESTRIDGE RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1229
Country	:	US
Telephone Number	:	310-562-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 ATLANTIC AVE STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1739
Country	:	US
Telephone Number	:	310-562-5258
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRYAN GEOFFREY ANDERSON
Credential	:	LCSW
Telephone Number	:	310-562-5258

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	11/12/2018

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Directions to “GRAB THE WHEEL KIDS ” Practice Location

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