Provider Demographics
NPI:1043605264
Name:PERSONAL INVOLVEMENT CENTER, INC.
Entity Type:Organization
Organization Name:PERSONAL INVOLVEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN-DIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:323-565-2300
Mailing Address - Street 1:PO BOX 514839
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-2839
Mailing Address - Country:US
Mailing Address - Phone:866-508-0311
Mailing Address - Fax:323-750-0018
Practice Address - Street 1:348 E AVENUE K4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4505
Practice Address - Country:US
Practice Address - Phone:866-508-0311
Practice Address - Fax:323-750-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7542AMedicaid