Healthcare Provider Details

I. General information

NPI: 1083484570
Provider Name (Legal Business Name): A STEP TO FREEDOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W 80TH ST
LOS ANGELES CA
90003-2422
US

IV. Provider business mailing address

164 W 80TH ST
LOS ANGELES CA
90003-2422
US

V. Phone/Fax

Practice location:
  • Phone: 888-617-7309
  • Fax:
Mailing address:
  • Phone: 888-617-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KENYA CROOM
Title or Position: CEO
Credential:
Phone: 888-617-7309