Provider Demographics
NPI:1639355191
Name:SPECIAL SERVICE FOR GROUPS
Entity Type:Organization
Organization Name:SPECIAL SERVICE FOR GROUPS
Other - Org Name:SSG-CHLA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:HATANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:213-553-1800
Mailing Address - Street 1:605 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1400
Mailing Address - Country:US
Mailing Address - Phone:213-553-1800
Mailing Address - Fax:213-553-1822
Practice Address - Street 1:5000 W SUNSET BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5861
Practice Address - Country:US
Practice Address - Phone:323-361-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health