Provider Demographics
NPI:1437216835
Name:DEPARTMENT MENTAL HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. COMMUNITY WORKER I
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-241-6844
Mailing Address - Street 1:11530 S NORMANDIE AVE
Mailing Address - Street 2:#11
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-1250
Mailing Address - Country:US
Mailing Address - Phone:323-241-6844
Mailing Address - Fax:323-756-1163
Practice Address - Street 1:2311 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3315
Practice Address - Country:US
Practice Address - Phone:323-241-6844
Practice Address - Fax:323-756-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty