Healthcare Provider Details

I. General information

NPI: 1568892495
Provider Name (Legal Business Name): SPECIAL SERVICE FOR GROUPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E PALMDALE BLVD SUITE 211
PALMDALE CA
93550-4750
US

IV. Provider business mailing address

905 E 8TH ST
LOS ANGELES CA
90021-1848
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax:
Mailing address:
  • Phone: 213-553-1800
  • Fax: 213-553-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HERBERT K HATANAKA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-553-1800