Provider Demographics
NPI:1629107719
Name:HOMES FOR LIFE FOUNDATION
Entity Type:Organization
Organization Name:HOMES FOR LIFE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-337-7417
Mailing Address - Street 1:8939 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3631
Mailing Address - Country:US
Mailing Address - Phone:310-337-7417
Mailing Address - Fax:310-337-7413
Practice Address - Street 1:26 S ALMANSOR ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3921
Practice Address - Country:US
Practice Address - Phone:310-337-7417
Practice Address - Fax:310-337-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7504AMedicaid