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General NPI Number Information
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NPI Number | 1467751800
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Entity Type | Organization
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Legal Business Name | HOMELESS HEALTH CARE LOS ANGELES
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 2330 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-2220
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Country | US
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Telephone | 213-739-1627
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Fax | 213-739-1617
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Provider Business Mailing Address
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Address Line | 2330 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-2220
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Country | US
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Telephone | 213-739-1627
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Fax | 213-739-1617
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARK CASANOVA
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Credential | MA
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Telephone | 213-739-1627
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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 | 190246AN
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License Number State | CA
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