Healthcare Provider Details

I. General information

NPI: 1487535480
Provider Name (Legal Business Name): SHILOH GOG MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 WHITTIER BLVD
LOS ANGELES CA
90022-4503
US

IV. Provider business mailing address

6125 WHITTIER BLVD
LOS ANGELES CA
90022-4503
US

V. Phone/Fax

Practice location:
  • Phone: 323-979-1980
  • Fax:
Mailing address:
  • Phone: 323-979-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number StateNULL

VIII. Authorized Official

Name: EILEEN S KNOX
Title or Position: DIRECTOR OF OPERATIONS
Credential: DPA
Phone: 310-279-8606