Healthcare Provider Details

I. General information

NPI: 1316486467
Provider Name (Legal Business Name): CHAPLAINCY CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVE SUITE 417
INGLEWOOD CA
90301-4502
US

IV. Provider business mailing address

10747 MAGNOLIA BLVD 418
NORTH HOLLYWOOD CA
91601-4093
US

V. Phone/Fax

Practice location:
  • Phone: 310-686-8490
  • Fax:
Mailing address:
  • Phone: 310-936-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. LEWIS E LOGAN II
Title or Position: CO FOUNDER
Credential:
Phone: 310-936-7703