Healthcare Provider Details

I. General information

NPI: 1669812392
Provider Name (Legal Business Name): THE ROADS FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 E LOS COYOTES DIAGONAL
LONG BEACH CA
90815-2827
US

IV. Provider business mailing address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax:
Mailing address:
  • Phone: 310-627-5850
  • Fax: 310-627-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAUNT AREVIAN
Title or Position: CEO
Credential: JD
Phone: 310-627-5850