Healthcare Provider Details

I. General information

NPI: 1023440336
Provider Name (Legal Business Name): SLEEP TIGHT TONIGHT TRANSITIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W 83RD ST
LOS ANGELES CA
90047-2939
US

IV. Provider business mailing address

4859 W SLAUSON AVE STE 437
LOS ANGELES CA
90056-3216
US

V. Phone/Fax

Practice location:
  • Phone: 310-743-5035
  • Fax: 323-293-9036
Mailing address:
  • Phone: 310-743-5035
  • Fax: 323-293-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CANDACE VIRGINIA BENTON
Title or Position: CEO
Credential: PHD
Phone: 310-743-5035