=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982735932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL SERVICE FOR GROUPS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 01/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4601 S BROADWAY FL 1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90037-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-234-4445
-----------------------------------------------------
Fax | 323-234-4477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 E 8TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90021-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-553-1800
-----------------------------------------------------
Fax | 213-553-1822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | HERBERT K HATANAKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-553-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------