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General NPI Number Information
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NPI Number | 1437318995
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Entity Type | Organization
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Legal Business Name | MEN BUILDING MEN YOUTH FOUNDATION
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 10813 CRENSHAW BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90303-2007
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Country | US
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Telephone | 323-447-7609
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Fax |
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Provider Business Mailing Address
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Address Line | 10813 CRENSHAW BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90303-2007
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Country | US
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Telephone | 323-447-7609
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Fax |
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Authorized Official
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Title or Position | COMPANYS PRESIDENT
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Name | KENNETH RICHARD
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Credential |
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Telephone | 323-447-7609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 190590BN
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License Number State | CA
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