Healthcare Provider Details

I. General information

NPI: 1568268951
Provider Name (Legal Business Name): MADE NEW FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

IV. Provider business mailing address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

V. Phone/Fax

Practice location:
  • Phone: 323-961-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL QUIROZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 323-961-4121