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General NPI Number Information
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NPI Number | 1982822995
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Entity Type | Organization
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Legal Business Name | PRIDE HEALTH SERVICES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8619 CRENSHAW BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90305-2330
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Country | US
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Telephone | 310-766-9019
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Fax | 310-677-9401
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Provider Business Mailing Address
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Address Line | 8619 CRENSHAW BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90305-2330
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Country | US
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Telephone | 310-766-9019
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Fax | 310-677-9401
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GODFREY NWOGENE
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Credential |
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Telephone | 310-677-9091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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