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General NPI Number Information
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NPI Number | 1609057447
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Entity Type | Organization
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Legal Business Name | OPPORTUNITY BAPTIST CHURCH, INC.
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 10513 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3021
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Country | US
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Telephone | 323-481-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 10513 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3021
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Country | US
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Telephone | 323-481-9800
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD WAYNE TAYLOR SR.
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Credential | BA
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Telephone | 323-481-9800
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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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