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General NPI Number Information
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NPI Number | 1831588839
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Entity Type | Organization
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Legal Business Name | QISMAH, INC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 879 W 190TH ST 400
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City | GARDENA
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State | CA
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Zip | 90248-4220
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Country | US
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Telephone | 310-217-4024
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Fax |
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Provider Business Mailing Address
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Address Line | 879 W 190TH ST 400
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City | GARDENA
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State | CA
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Zip | 90248-4223
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Country | US
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Telephone | 310-567-3647
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Fax | 310-719-8725
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | MRS. ANGELA HUFFMAN
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Credential |
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Telephone | 310-217-4024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 198205057
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License Number State | CA
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