=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700067600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUNNS HOPE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 959 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-677-1222
-----------------------------------------------------
Fax | 310-677-1199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 959 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. LOUIS NWEZE NWOKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-677-1222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 190554AP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------