Healthcare Provider Details

I. General information

NPI: 1851525380
Provider Name (Legal Business Name): HOMES FOR LIFE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N WILSON AVE
PASADENA CA
91106-2306
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD STE 460
LOS ANGELES CA
90045-3653
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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number191221043
License Number StateCA

VIII. Authorized Official

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