Healthcare Provider Details

I. General information

NPI: 1235062464
Provider Name (Legal Business Name): NEXT CHAPTER INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 E 109TH ST
LOS ANGELES CA
90059-1113
US

IV. Provider business mailing address

1463 E 109TH ST
LOS ANGELES CA
90059-1113
US

V. Phone/Fax

Practice location:
  • Phone: 323-241-7136
  • Fax:
Mailing address:
  • Phone: 323-241-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State

VIII. Authorized Official

Name: TAMARA ANNETTE JACKSON
Title or Position: OPERATION MANAGER
Credential: LVN
Phone: 626-590-6419