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General NPI Number Information
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NPI Number | 1053578393
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Entity Type | Organization
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Legal Business Name | HOME FROM HOME INC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 4125 SOUTH STREET
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City | LAKEWOOD
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State | CA
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Zip | 90711-1043
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Country | US
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Telephone | 562-682-3858
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Fax | 562-391-4442
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Provider Business Mailing Address
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Address Line | 4125 SOUTH STREET
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City | LAKEWOOD
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State | CA
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Zip | 90711
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Country | US
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Telephone | 562-682-3858
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Fax | 562-391-4442
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JULIUS IRUMUNDOMON
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Credential | RCP
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Telephone | 562-682-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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