Provider Demographics
NPI:1114217361
Name:HOPE WITH HELP OUT-PATIENT A.O.D. PROGRAM
Entity Type:Organization
Organization Name:HOPE WITH HELP OUT-PATIENT A.O.D. PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC
Authorized Official - Phone:323-299-4957
Mailing Address - Street 1:3756 SANTA ROSALIA DR STE 219
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3616
Mailing Address - Country:US
Mailing Address - Phone:323-299-4537
Mailing Address - Fax:
Practice Address - Street 1:1425 W MANCHESTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5439
Practice Address - Country:US
Practice Address - Phone:323-753-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HELP MINISTRY FELLOWSHIP Y.E.T.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health