Healthcare Provider Details

I. General information

NPI: 1275467136
Provider Name (Legal Business Name): SELAH FOUNDATION RE-ENTRY PROBLEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 W PIRU ST
COMPTON CA
90222-1609
US

IV. Provider business mailing address

1702 W PIRU ST
COMPTON CA
90222-1609
US

V. Phone/Fax

Practice location:
  • Phone: 310-345-4149
  • Fax: 562-278-2466
Mailing address:
  • Phone: 310-345-4149
  • Fax: 562-278-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: LAINA YOUNG
Title or Position: FOUNDER
Credential:
Phone: 310-345-4149