Provider Demographics
NPI:1528220407
Name:COUNTYWIDE RESOURCE MANAGEMENT
Entity Type:Organization
Organization Name:COUNTYWIDE RESOURCE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CASE WORKER I
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-266-4448
Mailing Address - Street 1:1925 DALY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3309
Mailing Address - Country:US
Mailing Address - Phone:323-226-4448
Mailing Address - Fax:323-223-8380
Practice Address - Street 1:1925 DALY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3309
Practice Address - Country:US
Practice Address - Phone:323-226-4448
Practice Address - Fax:323-223-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness