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General NPI Number Information
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NPI Number | 1962882332
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Entity Type | Organization
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Legal Business Name | AMANECER COMMUNITY COUNSELING SERVICE, A NON-PROFIT CORPORATION
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 3680 E IMPERIAL HWY STE 480
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City | LYNWOOD
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State | CA
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Zip | 90262-2662
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Country | US
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Telephone | 213-265-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 3680 E IMPERIAL HWY STE 480
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City | LYNWOOD
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State | CA
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Zip | 90262-2662
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Country | US
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Telephone | 213-265-1099
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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 | TEDDIE VALENZUELA
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Credential |
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Telephone | 213-481-7464
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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 | CA
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