=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710386107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3CHORDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 08/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3462 GAVIOTA AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90807-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-904-3262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 355 REDONDO AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90814-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-223-8002
-----------------------------------------------------
Fax | 562-912-3318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIMBERLY VIRGINIA GROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-904-3262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | BU21226960
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------