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General NPI Number Information
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NPI Number | 1871772251
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE OF LA INC.
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 2930 W IMPERIAL HWY SUITE 200M
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City | INGLEWOOD
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State | CA
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Zip | 90303-3143
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Country | US
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Telephone | 310-630-5820
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 W IMPERIAL HIGHWAY SUITE 200M
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City | INGLEWOOD
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State | CA
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Zip | 90303-3142
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Country | US
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Telephone | 310-630-5820
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JUDE NJOKU
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Credential | MBA
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Telephone | 310-908-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | NONE YET
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License Number State | CA
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