=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265898076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE AMAAD INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2016
-----------------------------------------------------
Last Update Date | 01/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10221 COMPTON AVE SUITE 105
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90002-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-569-1610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10221 COMPTON AVE SUITE 105
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90002-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-569-1610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE SOCIAL WORKER / C.E.O.
-----------------------------------------------------
Name | CARL HIGHSHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-569-1610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------