Healthcare Provider Details

I. General information

NPI: 1629107719
Provider Name (Legal Business Name): HOMES FOR LIFE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 S ALMANSOR ST
ALHAMBRA CA
91801-3921
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD SUITE 460
LOS ANGELES CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7417
  • Fax: 310-337-7413
Mailing address:
  • Phone: 310-337-7417
  • Fax: 310-337-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROL M LIESS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-337-7417