Healthcare Provider Details

I. General information

NPI: 1588400980
Provider Name (Legal Business Name): AHN FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 PEARCE AVE
LAKEWOOD CA
90712-2751
US

IV. Provider business mailing address

11331 183RD ST # 311
CERRITOS CA
90703-5434
US

V. Phone/Fax

Practice location:
  • Phone: 657-464-5004
  • Fax:
Mailing address:
  • Phone: 657-464-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA COULTER
Title or Position: CEO
Credential:
Phone: 657-464-5004