Healthcare Provider Details

I. General information

NPI: 1528428463
Provider Name (Legal Business Name): PRAADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7719 S HALLDALE AVE
LOS ANGELES CA
90047-2518
US

IV. Provider business mailing address

19170 PEMBERTON PL
RIVERSIDE CA
92508-6010
US

V. Phone/Fax

Practice location:
  • Phone: 951-426-7482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN ARMSTEAD
Title or Position: EXECUTIVE DIRECTOR
Credential: B.A.
Phone: 951-426-7482