MEDICARE: 1ST MENDING POINT 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1891941357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST MENDING POINT INC.

Provider Business Mailing Address
First Line	:	14532 FRIAR ST STE G
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2358
Country	:	US
Telephone Number	:	818-613-9847
Fax Number	:

Provider Business Practice Location Address
First Line	:	14532 FRIAR ST STE G
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2358
Country	:	US
Telephone Number	:	818-613-9847
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PAUL NIIYAMA
Credential	:
Telephone Number	:	818-613-9847

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	10/30/2009

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Directions to “1ST MENDING POINT INC. ” Practice Location

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