Healthcare Provider Details

I. General information

NPI: 1184898900
Provider Name (Legal Business Name): HOME FOR LIFE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH GIBSON
Title or Position: EXECUTIVE ADMINISTRATION
Credential:
Phone: 310-337-7417