MEDICARE: BERNIE'S LIL WOMEN CENTER, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	190472AN	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366429185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNIE'S LIL WOMEN CENTER, INC.

Provider Business Mailing Address
First Line	:	942 E 116TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-1602
Country	:	US
Telephone Number	:	213-280-1012
Fax Number	:	323-563-7087

Provider Business Practice Location Address
First Line	:	8042 YOLANDA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1257
Country	:	US
Telephone Number	:	213-280-1012
Fax Number	:	323-563-7087

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. BERNADINE GOUDEAU
Credential	:
Telephone Number	:	213-280-1012

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	08/22/2020

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