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General NPI Number Information
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NPI Number | 1548488539
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Entity Type | Organization
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Legal Business Name | ASSISTANCE LEAGUE OF SOUTHERN CA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1360 N ST ANDREWS PL
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City | HOLLYWOOD
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State | CA
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Zip | 90028-8529
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Country | US
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Telephone | 323-469-5893
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Fax | 323-469-5896
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Provider Business Mailing Address
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Address Line | 1360 N ST ANDREWS PL
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City | HOLLYWOOD
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State | CA
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Zip | 90028-8529
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Country | US
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Telephone | 323-469-5893
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Fax | 323-469-5896
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. PETER FONSECA
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Credential | MA.ED.
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Telephone | 323-469-5893
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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 | 245-0811-1
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License Number State | CA
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