Healthcare Provider Details

I. General information

NPI: 1891810560
Provider Name (Legal Business Name): BERNIE'S LIL WOMEN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 S CENTRAL AVE SUITE 205
LOS ANGELES CA
90059-2836
US

IV. Provider business mailing address

942 E 116TH ST
LOS ANGELES CA
90059-1602
US

V. Phone/Fax

Practice location:
  • Phone: 323-249-9026
  • Fax: 323-563-7087
Mailing address:
  • Phone: 213-280-1012
  • Fax: 323-563-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190472BN
License Number StateCA

VIII. Authorized Official

Name: MS. BERNADINE GOUDEAU
Title or Position: CEO
Credential:
Phone: 213-280-1012