Provider Demographics
NPI:1568652915
Name:CITY OF GARDENA
Entity Type:Organization
Organization Name:CITY OF GARDENA
Other - Org Name:GARDENA SOCIALIZATION & ACTIVITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECREATION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAKUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-217-9552
Mailing Address - Street 1:1670 W 162ND ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3734
Mailing Address - Country:US
Mailing Address - Phone:310-217-9552
Mailing Address - Fax:
Practice Address - Street 1:2320 W 149TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3702
Practice Address - Country:US
Practice Address - Phone:310-217-9537
Practice Address - Fax:310-217-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)