Provider Demographics
NPI:1114051240
Name:FIVE ACRES- THE BOYS' AND GIRLS' AID SOCIETY OF LOS ANGELES COUNTY
Entity Type:Organization
Organization Name:FIVE ACRES- THE BOYS' AND GIRLS' AID SOCIETY OF LOS ANGELES COUNTY
Other - Org Name:FIVE ACRES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLAIMS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHAULON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-798-6793
Mailing Address - Street 1:760 WEST MOUNTAIN VIEW STREET
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4925
Mailing Address - Country:US
Mailing Address - Phone:626-798-6793
Mailing Address - Fax:626-792-7722
Practice Address - Street 1:760 WEST MOUNTAIN VIEW STREET
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001
Practice Address - Country:US
Practice Address - Phone:626-798-6793
Practice Address - Fax:626-792-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management