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General NPI Number Information
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NPI Number | 1558921601
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Entity Type | Organization
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Legal Business Name | CRENSHAW COMMUNITY CENTER LLC
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 1060 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-1900
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Country | US
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Telephone | 213-804-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-1939
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Country | US
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Telephone | 213-201-7700
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Fax | 213-201-7701
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Authorized Official
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Title or Position | CEO
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Name | HELEN KIM
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Credential |
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Telephone | 213-604-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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