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General NPI Number Information
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NPI Number | 1720327356
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Entity Type | Organization
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Legal Business Name | GIFT OF HOPE AND HEALING, INC. SATELLITE
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 1541 W 110TH ST DUKE ELINGTON HIGH SCHOOL
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City | LOS ANGELES
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State | CA
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Zip | 90047-4912
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Country | US
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Telephone | 323-565-2043
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Fax | 323-565-2044
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Provider Business Mailing Address
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Address Line | 8455 S VAN NESS AVE
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City | INGLEWOOD
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State | CA
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Zip | 90305-1519
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Country | US
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Telephone | 323-565-2043
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Fax | 323-565-2044
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARK AWANYAI SR.
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Credential |
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Telephone | 323-565-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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