MEDICARE: FAMILY PROMISE OF THE SOUTH BAY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1841064383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PROMISE OF THE SOUTH BAY

Provider Business Mailing Address
First Line	:	2930 EL DORADO ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6062
Country	:	US
Telephone Number	:	310-782-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 EL DORADO ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6062
Country	:	US
Telephone Number	:	310-782-8196
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LORI EASTMAN
Credential	:
Telephone Number	:	310-782-8196

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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Directions to “FAMILY PROMISE OF THE SOUTH BAY ” Practice Location

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