MEDICARE: SHILOH GOG MINISTRIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	101YM0800X	Mental Health Counselor
4	177F00000X	Lodging Provider
5	251B00000X	Case Management Agency
6	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1487535480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH GOG MINISTRIES

Provider Business Mailing Address
First Line	:	6125 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4503
Country	:	US
Telephone Number	:	323-979-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4503
Country	:	US
Telephone Number	:	323-979-1980
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	EILEEN S KNOX
Credential	:	DPA
Telephone Number	:	310-279-8606

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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Directions to “SHILOH GOG MINISTRIES ” Practice Location

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