Healthcare Provider Details

I. General information

NPI: 1700359437
Provider Name (Legal Business Name): FLEMING & BARNES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 E GLADWICK ST
CARSON CA
90746-2570
US

IV. Provider business mailing address

PO BOX 4446
PALOS VERDES ESTATES CA
90274-9595
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax: 310-791-3084
Mailing address:
  • Phone: 310-791-3064
  • Fax: 310-791-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH FLEMING
Title or Position: DIRECTOR
Credential:
Phone: 310-791-3064