Healthcare Provider Details

I. General information

NPI: 1245969203
Provider Name (Legal Business Name): 17TH DISTRICT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 CAHUENGA BLVD W
LOS ANGELES CA
90068-1366
US

IV. Provider business mailing address

13547 VENTURA BLVD # 232
SHERMAN OAKS CA
91423-3825
US

V. Phone/Fax

Practice location:
  • Phone: 323-517-3178
  • Fax:
Mailing address:
  • Phone: 323-517-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: RASHAD SCROGGINS
Title or Position: CEO
Credential:
Phone: 323-517-3178