Healthcare Provider Details

I. General information

NPI: 1518879113
Provider Name (Legal Business Name): CHOSEN GOSPEL RECOVERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 55TH ST
LOS ANGELES CA
90037-4001
US

IV. Provider business mailing address

417 W 55TH ST
LOS ANGELES CA
90037-4001
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-6902
  • Fax: --
Mailing address:
  • Phone: 323-244-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DARLENE YVETTE WATLEY
Title or Position: CEO
Credential:
Phone: 323-244-6902