Provider Demographics
NPI:1528199643
Name:ONE IN LONG BEACH, INC.
Entity Type:Organization
Organization Name:ONE IN LONG BEACH, INC.
Other - Org Name:THE LGBTQ CENTER OF LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PORTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-434-4455
Mailing Address - Street 1:2017 E. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-1001
Mailing Address - Country:US
Mailing Address - Phone:562-434-4455
Mailing Address - Fax:562-433-6428
Practice Address - Street 1:2017 E. 4TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-1001
Practice Address - Country:US
Practice Address - Phone:562-434-4455
Practice Address - Fax:562-433-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7377COtherDMH PROVIDER NUMBER