MEDICARE: FAMILY ENRICHMENT HOUSING & DEVELOPMENT CORPORATION

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	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1477310548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ENRICHMENT HOUSING & DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	1119 STONEBRYN DR
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-1544
Country	:	US
Telephone Number	:	562-335-6503
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 LINDEN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4520
Country	:	US
Telephone Number	:	310-738-6982
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE SCOTT RILEY
Credential	:	LMFT
Telephone Number	:	562-335-6503

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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