Healthcare Provider Details

I. General information

NPI: 1154210359
Provider Name (Legal Business Name): RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 FOUNTAIN AVE
LOS ANGELES CA
90029-1913
US

IV. Provider business mailing address

4560 FOUNTAIN AVE
LOS ANGELES CA
90029-1913
US

V. Phone/Fax

Practice location:
  • Phone: 805-368-0294
  • Fax:
Mailing address:
  • Phone: 805-368-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: VICKI HOLLOWAY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 323-644-3094