Healthcare Provider Details

I. General information

NPI: 1528220407
Provider Name (Legal Business Name): COUNTYWIDE RESOURCE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 DALY ST 2ND FLOOR
LOS ANGELES CA
90031-3309
US

IV. Provider business mailing address

1925 DALY ST 2ND FLOOR
LOS ANGELES CA
90031-3309
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-4448
  • Fax: 323-223-8380
Mailing address:
  • Phone: 323-226-4448
  • Fax: 323-223-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICA LOBERG
Title or Position: MEDICAL CASE WORKER I
Credential:
Phone: 323-266-4448