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General NPI Number Information
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NPI Number | 1023787397
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Entity Type | Organization
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Legal Business Name | A LEAGUE OF ACTION COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 252 BROADWAY APT 620
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City | TACOMA
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State | WA
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Zip | 98402-4003
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Country | US
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Telephone | 253-398-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89118-2506
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Country | US
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Telephone | 253-398-0203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLITA HARRIS
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Credential |
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Telephone | 253-398-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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