Healthcare Provider Details

I. General information

NPI: 1841064383
Provider Name (Legal Business Name): FAMILY PROMISE OF THE SOUTH BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 EL DORADO ST
TORRANCE CA
90503-6062
US

IV. Provider business mailing address

2930 EL DORADO ST
TORRANCE CA
90503-6062
US

V. Phone/Fax

Practice location:
  • Phone: 310-782-8196
  • Fax:
Mailing address:
  • Phone: 310-782-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORI EASTMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-782-8196