Provider Demographics
NPI:1689053548
Name:SPECIAL SERVICE FOR GROUPS
Entity Type:Organization
Organization Name:SPECIAL SERVICE FOR GROUPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH STUDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-948-0444
Mailing Address - Street 1:5715 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4131
Mailing Address - Country:US
Mailing Address - Phone:323-948-0444
Mailing Address - Fax:323-948-0419
Practice Address - Street 1:5715 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4131
Practice Address - Country:US
Practice Address - Phone:323-948-0444
Practice Address - Fax:323-948-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable