Healthcare Provider Details

I. General information

NPI: 1245637362
Provider Name (Legal Business Name): GOD'S PROPERTY SOBER LIVING FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W MANCHESTER AVE SUITE 210
LOS ANGELES CA
90047-3063
US

IV. Provider business mailing address

1704 W MANCHESTER AVE SUITE 210
LOS ANGELES CA
90047-3063
US

V. Phone/Fax

Practice location:
  • Phone: 323-305-1538
  • Fax: 323-305-1776
Mailing address:
  • Phone: 323-305-1538
  • Fax: 323-305-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN DERRICK FLEMING
Title or Position: PRESIDENT
Credential:
Phone: 323-420-7345