Healthcare Provider Details

I. General information

NPI: 1992136915
Provider Name (Legal Business Name): HEALING ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2013
Last Update Date: 12/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 E WASHINGTON BLVD 664
PASADENA CA
91104-2650
US

IV. Provider business mailing address

1443 E WASHINGTON BLVD 664
PASADENA CA
91104-2650
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7111
  • Fax:
Mailing address:
  • Phone: 626-765-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberCEP 15950
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number45185912
License Number StateCA

VIII. Authorized Official

Name: MARLENE ASDOURIAN
Title or Position: DIRECTING MANAGER
Credential:
Phone: 626-755-6757