Healthcare Provider Details

I. General information

NPI: 1346854973
Provider Name (Legal Business Name): A HOME FOR OUR VETERANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W 236TH ST
TORRANCE CA
90501-5742
US

IV. Provider business mailing address

318 AVENUE I # 218
REDONDO BEACH CA
90277-5601
US

V. Phone/Fax

Practice location:
  • Phone: 310-567-9251
  • Fax:
Mailing address:
  • Phone: 310-567-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRYL SEWELL
Title or Position: CEO
Credential:
Phone: 310-567-9251