MEDICARE: TOTAL FAMILY SUPPORT CLINIC

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	251B00000X	Case Management Agency

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	:	1629372057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL FAMILY SUPPORT CLINIC

Provider Business Mailing Address
First Line	:	830 S OLIVE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-3006
Country	:	US
Telephone Number	:	213-213-0581
Fax Number	:	213-213-0580

Provider Business Practice Location Address
First Line	:	6850 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-2354
Country	:	US
Telephone Number	:	818-673-1300
Fax Number	:	818-702-8942

Authorized Official
Title or Position	:	DIRECTOR OF HR
Name	:	MRS. MARINA VERKHOVSKY
Credential	:	MS
Telephone Number	:	213-213-0581

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	06/01/2011

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Directions to “TOTAL FAMILY SUPPORT CLINIC ” Practice Location

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