Provider Demographics
NPI:1376721639
Name:AMICUS INC
Entity Type:Organization
Organization Name:AMICUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-683-8321
Mailing Address - Street 1:PO BOX 480179
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1179
Mailing Address - Country:US
Mailing Address - Phone:323-683-8321
Mailing Address - Fax:651-400-5476
Practice Address - Street 1:645 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5712
Practice Address - Country:US
Practice Address - Phone:323-683-8321
Practice Address - Fax:651-400-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X, 251V00000X
251K00000X, 261QD1600X, 261QH0700X, 261QM1300X, 261QR0400X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation