Healthcare Provider Details

I. General information

NPI: 1326864455
Provider Name (Legal Business Name): UNCLE DAVE'S HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 W 78TH ST
LOS ANGELES CA
90044-5001
US

IV. Provider business mailing address

844 W 78TH ST
LOS ANGELES CA
90044-5001
US

V. Phone/Fax

Practice location:
  • Phone: 310-597-0666
  • Fax:
Mailing address:
  • Phone: 310-597-0666
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: FELICIA EDELMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-597-0666