Healthcare Provider Details

I. General information

NPI: 1639680911
Provider Name (Legal Business Name): LOVING HANDS FAMILY SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 PACIFIC BLVD STE 306
HUNTINGTON PARK CA
90255-4104
US

IV. Provider business mailing address

PO BOX 40043
DOWNEY CA
90239-1043
US

V. Phone/Fax

Practice location:
  • Phone: 323-973-0735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name: JANET JARQUIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-973-0735