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General NPI Number Information
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NPI Number | 1184769143
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Entity Type | Organization
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Legal Business Name | GORETTI HEALTH SERVICES INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14623 HAWTHORNE BLVD SUITE 306
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City | LAWNDALE
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State | CA
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Zip | 90260-1581
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Country | US
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Telephone | 310-973-0100
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Fax | 310-973-0099
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Provider Business Mailing Address
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Address Line | 14623 HAWTHORNE BLVD SUITE 306
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City | LAWNDALE
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State | CA
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Zip | 90260-1581
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Country | US
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Telephone | 310-973-0100
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Fax | 310-973-0099
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. RICHARDS BEDE NZENWA
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Credential | PHD BUSSINESS ADMI
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Telephone | 310-973-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190559AN
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License Number State | CA
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