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General NPI Number Information
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NPI Number | 1497897367
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Entity Type | Organization
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Legal Business Name | VILLAGE HEALTH FOUNDATION, INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4073-75 W. PICO BLVD.
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City | LOS ANGELES
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State | CA
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Zip | 90019-4308
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Country | US
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Telephone | 323-733-0471
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Fax | 323-733-6427
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Provider Business Mailing Address
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Address Line | 4073-75 W. PICO BLVD.
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City | LOS ANGELES
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State | CA
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Zip | 90019-4308
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Country | US
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Telephone | 323-733-0471
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Fax | 323-733-6427
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEWEL THAIS-WILLIAMS
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Credential | L.AC.
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Telephone | 323-733-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | AC6736
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License Number State | CA
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