MEDICARE: SS.INTERNATIONAL COMMUNITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184587966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SS.INTERNATIONAL COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	155 W 57TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-4113
Country	:	US
Telephone Number	:	213-766-5712
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 W 57TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-4113
Country	:	US
Telephone Number	:	213-766-5712
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR/COMMUNITY HEALTH W
Name	:	SAMARA L MILLER
Credential	:
Telephone Number	:	213-431-2364

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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