Healthcare Provider Details

I. General information

NPI: 1821302886
Provider Name (Legal Business Name): HIS SHELTERING ARMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 S MAIN ST
LOS ANGELES CA
90061-1925
US

IV. Provider business mailing address

11101 S MAIN ST
LOS ANGELES CA
90061-1925
US

V. Phone/Fax

Practice location:
  • Phone: 323-755-6646
  • Fax: 323-776-1106
Mailing address:
  • Phone: 323-755-6646
  • Fax: 323-776-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number190064CN
License Number StateCA

VIII. Authorized Official

Name: MS. RHOEN D MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-755-6646