Healthcare Provider Details

I. General information

NPI: 1437208923
Provider Name (Legal Business Name): ARMS OF GRACE HUMANITARIAN SERVICES, ADPCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 W FLORENCE AVE
LOS ANGELES CA
90043-5110
US

IV. Provider business mailing address

2931 W FLORENCE AVE
LOS ANGELES CA
90043-5110
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-8040
  • Fax: 323-750-8040
Mailing address:
  • Phone: 323-750-8040
  • Fax: 323-750-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER O IRUKE
Title or Position: CEO
Credential:
Phone: 323-750-8040