Healthcare Provider Details

I. General information

NPI: 1609018696
Provider Name (Legal Business Name): BERNIE'S LIL WOMEN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 S WILMINGTON AVE
COMPTON CA
90222-1220
US

IV. Provider business mailing address

942 E 116TH ST
LOS ANGELES CA
90059-1602
US

V. Phone/Fax

Practice location:
  • Phone: 213-280-1012
  • Fax: 323-249-8367
Mailing address:
  • Phone: 213-280-1012
  • Fax: 323-249-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BERNADINE GOUDEAU
Title or Position: PRESIDENT/CEO
Credential:
Phone: 213-280-1012