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General NPI Number Information
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NPI Number | 1336780774
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Entity Type | Organization
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Legal Business Name | A.F.F.R.E.E.C.A.
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 879 W 190TH ST STE 430
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City | GARDENA
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State | CA
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Zip | 90248-4273
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Country | US
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Telephone | 310-590-8740
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Fax |
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Provider Business Mailing Address
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Address Line | 879 W 190TH ST STE 430
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City | GARDENA
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State | CA
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Zip | 90248-4273
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Country | US
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Telephone | 310-590-8740
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Fax | 310-532-0763
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Authorized Official
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Title or Position | LVN
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Name | IVY NGENE
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Credential | LVN
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Telephone | 310-590-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 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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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 261QC1500X
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Taxonomy Name | Community Health 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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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