MEDICARE: ABLE FAMILY SUPPORT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17980801944	OTHER	CA	DRUG MEDI-CAL

General Provider Information

NPI Number	:	1710258389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLE FAMILY SUPPORT

Provider Business Mailing Address
First Line	:	14418 CHASE ST
Second Line	:	200
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3022
Country	:	US
Telephone Number	:	310-500-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034-1036 W. 97TH ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044
Country	:	US
Telephone Number	:	310-500-8902
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ALEXANDER FERDMAN
Credential	:
Telephone Number	:	310-500-8902

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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Directions to “ABLE FAMILY SUPPORT ” Practice Location

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