Healthcare Provider Details

I. General information

NPI: 1831753615
Provider Name (Legal Business Name): SPECIAL SERVICE FOR GROUPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S BROADWAY AVENUE
LOS ANGELES CA
90037-2729
US

IV. Provider business mailing address

905 E 8TH ST
LOS ANGELES CA
90021-1848
US

V. Phone/Fax

Practice location:
  • Phone: 213-223-5922
  • Fax: 323-897-5334
Mailing address:
  • Phone: 213-553-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HERBERT K HATANAKA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-553-1800