Healthcare Provider Details

I. General information

NPI: 1023237161
Provider Name (Legal Business Name): LA CADA HOMELESS OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S CENTRAL AVE
LOS ANGELES CA
90013-1724
US

IV. Provider business mailing address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
US

V. Phone/Fax

Practice location:
  • Phone: 213-622-6411
  • Fax:
Mailing address:
  • Phone: 562-906-2676
  • Fax: 562-906-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number790100BN
License Number StateCA

VIII. Authorized Official

Name: MR. ADOLFO ESTRADA
Title or Position: ADMINISTRATIVE COORDINATOR
Credential:
Phone: 562-906-2676