Healthcare Provider Details

I. General information

NPI: 1780843425
Provider Name (Legal Business Name): OGDEN HOME CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 N OGDEN DR
WEST HOLLYWOOD CA
90046-7310
US

IV. Provider business mailing address

906 N OGDEN DR
WEST HOLLYWOOD CA
90046-7310
US

V. Phone/Fax

Practice location:
  • Phone: 323-650-6588
  • Fax:
Mailing address:
  • Phone: 323-650-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number191800521
License Number StateCA

VIII. Authorized Official

Name: MR. ALLEN SAMSON
Title or Position: ADM.
Credential:
Phone: 323-650-6588