Healthcare Provider Details

I. General information

NPI: 1982990529
Provider Name (Legal Business Name): SUPPLEMENTAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 GOLDEN SHORE SUITE 250
LONG BEACH CA
90802
US

IV. Provider business mailing address

PO BOX 1352
HERMOSA BEACH CA
90254-1352
US

V. Phone/Fax

Practice location:
  • Phone: 626-437-9624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number10677
License Number StateCA

VIII. Authorized Official

Name: MISS LINDA ABELES
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 626-437-9624