Provider Demographics
NPI:1073828638
Name:A HOME FOR US FOUNDATION INCORPORATED
Entity Type:Organization
Organization Name:A HOME FOR US FOUNDATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:MARCIA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, M FTI
Authorized Official - Phone:323-348-4134
Mailing Address - Street 1:3817 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1901
Mailing Address - Country:US
Mailing Address - Phone:323-348-4134
Mailing Address - Fax:323-292-5543
Practice Address - Street 1:5010 11TH AVE
Practice Address - Street 2:ROOM 106 & 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4816
Practice Address - Country:US
Practice Address - Phone:323-348-4134
Practice Address - Fax:323-292-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-08
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190449AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437362647OtherDRUG MEDI CAL