Healthcare Provider Details

I. General information

NPI: 1790690931
Provider Name (Legal Business Name): ARMS OF NEFERTARI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 W 85TH ST
INGLEWOOD CA
90305-1824
US

IV. Provider business mailing address

2808 W 85TH ST
INGLEWOOD CA
90305-1824
US

V. Phone/Fax

Practice location:
  • Phone: 213-796-2586
  • Fax: 424-702-4295
Mailing address:
  • Phone: 213-796-2586
  • Fax: 424-702-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH LAVAN HICKS
Title or Position: CEO/FOUNDER
Credential:
Phone: 213-796-2586