Healthcare Provider Details

I. General information

NPI: 1871191932
Provider Name (Legal Business Name): ONE FAMILY HEALTH ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E 185TH ST
CARSON CA
90746-1706
US

IV. Provider business mailing address

206 E 185TH ST
CARSON CA
90746-1706
US

V. Phone/Fax

Practice location:
  • Phone: 562-500-0285
  • Fax:
Mailing address:
  • Phone: 562-500-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. FELICIA RENEE HOLLEY
Title or Position: PRESIDENT
Credential:
Phone: 562-500-0285