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General NPI Number Information
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NPI Number | 1497570162
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Entity Type | Organization
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Legal Business Name | T.D.D. SUPPORTIVE LIVING INC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 235 W 99TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90003-4116
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Country | US
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Telephone | 323-899-9398
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Fax | 323-978-6903
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Provider Business Mailing Address
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Address Line | 4604 S VICTORIA AVE
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City | VIEW PARK
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State | CA
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Zip | 90043-1214
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Country | US
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Telephone | 323-899-9398
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Fax | 323-978-6903
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Authorized Official
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Title or Position | CEO
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Name | DEBORAH ROBERSON
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Credential | CMPSS #MPSS-OUQDWB
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Telephone | 323-899-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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