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General NPI Number Information
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NPI Number | 1215584461
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Entity Type | Organization
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Legal Business Name | HER HEALING COMMUNITY
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 451 N CANON DR STE 1
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4890
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Country | US
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Telephone | 310-595-0257
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S SPRING ST UNIT 1202
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City | LOS ANGELES
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State | CA
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Zip | 90014-1986
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXANDRIA TILLARD-GATES
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Credential |
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Telephone | 310-595-0257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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