Healthcare Provider Details

I. General information

NPI: 1780422808
Provider Name (Legal Business Name): RONNIES HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6082 ATLANTIC AVE
LONG BEACH CA
90805-3000
US

IV. Provider business mailing address

6082 ATLANTIC AVE
LONG BEACH CA
90805-3000
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-3851
  • Fax:
Mailing address:
  • Phone: 562-285-3851
  • 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 Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: SHIRIN EL SHARKWAI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 562-285-3851