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General NPI Number Information
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NPI Number | 1609129592
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Entity Type | Organization
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Legal Business Name | THE VILLAGE HEALTH FOUNDATION INC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 4073 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 WEST PICO BOULEVARD
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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 | FOUNDING CEO
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Name | MISS JEWEL THAIS-WILLIAMS
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Credential | LIC. ACUPUNTURIST
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AC6736
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License Number State | CA
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