Healthcare Provider Details

I. General information

NPI: 1669616827
Provider Name (Legal Business Name): ARMS OF GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 W FLORENCE AVE
LOS ANGELES CA
90043-5110
US

IV. Provider business mailing address

2931 W FLORENCE AVE
LOS ANGELES CA
90043-5110
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-8040
  • Fax: 323-750-8075
Mailing address:
  • Phone: 323-750-8040
  • Fax: 323-750-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN L. BROWN SR.
Title or Position: PROGRAM COOR.
Credential: DIPLOMA
Phone: 323-750-8040