Provider Demographics
NPI:1508278359
Name:THE ROADS FOUNDATION, INC.
Entity Type:Organization
Organization Name:THE ROADS FOUNDATION, INC.
Other - Org Name:ROADS COMMUNITY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOSELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-627-5850
Mailing Address - Street 1:121 S LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3423
Mailing Address - Country:US
Mailing Address - Phone:310-627-5850
Mailing Address - Fax:310-627-5855
Practice Address - Street 1:121 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3423
Practice Address - Country:US
Practice Address - Phone:310-627-5850
Practice Address - Fax:310-627-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QD0000X, 261QM0850X
CA550002986261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751804Medicare Oscar/Certification