Provider Demographics
NPI:1043458474
Name:TRAVELERS AID SOCIETY OF LOS ANGELES, CALIFORNIA
Entity Type:Organization
Organization Name:TRAVELERS AID SOCIETY OF LOS ANGELES, CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:323-644-3500
Mailing Address - Street 1:1507 WINONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5003
Mailing Address - Country:US
Mailing Address - Phone:323-644-3500
Mailing Address - Fax:323-644-3505
Practice Address - Street 1:1507 WINONA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5003
Practice Address - Country:US
Practice Address - Phone:323-644-3500
Practice Address - Fax:323-644-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable