=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780242404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRYE PERSON WITH UNIQUE DISABILITY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2019
-----------------------------------------------------
Last Update Date | 05/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4130 W 161ST ST
-----------------------------------------------------
City | LAWNDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90260-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-323-1895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4130 W 161ST ST
-----------------------------------------------------
City | LAWNDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90260-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-323-1895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MS. MYRTLE L CHAPMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 424-323-1895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------