Provider Demographics
NPI:1487830279
Name:P.E.L.S.A
Entity Type:Organization
Organization Name:P.E.L.S.A
Other - Org Name:(PROVIDING EVERYONE LIVING SOBER ASSISTANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, CFO, CLINICAL DIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA, MSN-C
Authorized Official - Phone:310-383-7624
Mailing Address - Street 1:15363 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2754
Mailing Address - Country:US
Mailing Address - Phone:310-383-7624
Mailing Address - Fax:909-393-6622
Practice Address - Street 1:15363 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2754
Practice Address - Country:US
Practice Address - Phone:310-383-7624
Practice Address - Fax:909-393-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health