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General NPI Number Information
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NPI Number | 1821261207
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Entity Type | Organization
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Legal Business Name | PRIDE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 8904 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-4834
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Country | US
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Telephone | 323-753-5950
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Fax | 323-753-6020
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Provider Business Mailing Address
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Address Line | 8904 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-4834
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Country | US
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Telephone | 323-753-5950
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Fax | 323-753-6020
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MRS. KATHY SHAKIR
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Credential |
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Telephone | 310-677-9019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 90318188
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License Number State | CA
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