MEDICARE: SPECIAL SERVICE FOR GROUPS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801927710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL SERVICE FOR GROUPS, INC.

Provider Business Mailing Address
First Line	:	905 E 8TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1848
Country	:	US
Telephone Number	:	213-553-1800
Fax Number	:	213-553-1822

Provider Business Practice Location Address
First Line	:	515 COLUMBIA AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1209
Country	:	US
Telephone Number	:	213-249-9388
Fax Number	:	213-389-7993

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	HERBERT K HATANAKA
Credential	:
Telephone Number	:	213-553-1800

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	11/23/2021

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