Healthcare Provider Details

I. General information

NPI: 1902227010
Provider Name (Legal Business Name): ENTERTAINMENT INTERNATIONAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W COMPTON BLVD
COMPTON CA
90220-3110
US

IV. Provider business mailing address

357 W COMPTON BLVD
COMPTON CA
90220-3110
US

V. Phone/Fax

Practice location:
  • Phone: 310-605-5268
  • Fax:
Mailing address:
  • Phone: 877-784-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number#2C-05-877-1015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ISAIAH RICARDO JENKINS
Title or Position: CFO
Credential:
Phone: 877-784-0816