=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659523918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HOUSE OF HOPE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2008
-----------------------------------------------------
Last Update Date | 10/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 S LA BREA AVE SUITE A
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-3891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-678-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 S LA BREA AVE SUITE A
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-3891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-678-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. ABERA GEBRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-678-5886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 190633AN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------