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General NPI Number Information
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NPI Number | 1942609771
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Entity Type | Organization
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Legal Business Name | PENNACLE FOUNDATION, INC.
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 5125 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90043-1853
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Country | US
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Telephone | 323-750-2400
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Fax | 323-825-5660
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Provider Business Mailing Address
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Address Line | PO BOX 18224
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City | LOS ANGELES
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State | CA
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Zip | 90018-0224
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Country | US
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Telephone | 323-750-2400
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Fax | 323-825-5660
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CAROLYN RUFFIN
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Credential |
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Telephone | 323-750-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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