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General NPI Number Information
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NPI Number | 1427442557
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Entity Type | Organization
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Legal Business Name | FIVE ACRES- THE BOYS' AND GIRLS' AID SOCIETY OF LOS ANGELES COUNTY
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 7356 PAINTER AVE 102
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City | WHITTIER
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State | CA
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Zip | 90602-1853
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Country | US
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Telephone | 626-798-6793
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Fax |
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Provider Business Mailing Address
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Address Line | 760 MOUNTAIN VIEW ST
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City | ALTADENA
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State | CA
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Zip | 91001-4925
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Country | US
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Telephone | 626-798-6793
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Fax |
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Authorized Official
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Title or Position | DIRECTOF OF CLAIMS OPERATIONS
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Name | SHAULON SHANKLIN
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Credential |
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Telephone | 626-798-9763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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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 | 251B00000X
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Taxonomy Name | Case Management 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 | 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 #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 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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