Healthcare Provider Details

I. General information

NPI: 1437287489
Provider Name (Legal Business Name): HOMES FOR LIFE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD SUITE NUMBER 460
LOS ANGELES CA
90045-3631
US

IV. Provider business mailing address

83 BRIARWOOD LN
ALISO VIEJO CA
92656-2963
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7417
  • Fax:
Mailing address:
  • Phone: 949-305-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. CAROL M LIESS
Title or Position: EXECUTIVE DIRECTOR AND FACILITY ADM
Credential:
Phone: 310-337-7417