Healthcare Provider Details

I. General information

NPI: 1124401252
Provider Name (Legal Business Name): BETTER LIFE CBAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 S CARONDELET ST
LOS ANGELES CA
90057-3308
US

IV. Provider business mailing address

672 S CARONDELET ST
LOS ANGELES CA
90057-3308
US

V. Phone/Fax

Practice location:
  • Phone: 213-392-0033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000837
License Number StateCA

VIII. Authorized Official

Name: HO KYUNG LEE
Title or Position: PRESIDENT
Credential:
Phone: 213-392-0033