Healthcare Provider Details

I. General information

NPI: 1669503629
Provider Name (Legal Business Name): SPECIAL SERVICE FOR GROUPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST SUITES 320 350 360 380 390
GARDENA CA
90248-4223
US

IV. Provider business mailing address

905 E 8TH ST
LOS ANGELES CA
90021-1848
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax: 310-323-1570
Mailing address:
  • Phone: 213-553-1800
  • Fax: 213-553-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HERBERT K HATANAKA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-553-1800