Healthcare Provider Details

I. General information

NPI: 1720967151
Provider Name (Legal Business Name): HOMES FOR LIFE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 S MONTEREY ST
ALHAMBRA CA
91801-8403
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD STE 460
LOS ANGELES CA
90045-3653
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7417
  • Fax:
Mailing address:
  • Phone: 310-337-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH E GIBSON
Title or Position: QA & COMPLIANCE MANAGER
Credential:
Phone: 310-337-7417