Provider Demographics
NPI:1710107594
Name:ASSISTANCE LEAGUE OF SOUTHERN CA
Entity Type:Organization
Organization Name:ASSISTANCE LEAGUE OF SOUTHERN CA
Other - Org Name:PASADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MECIAS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:626-395-9307
Mailing Address - Street 1:40 N ALTADENA DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3386
Mailing Address - Country:US
Mailing Address - Phone:626-395-9307
Mailing Address - Fax:626-395-9310
Practice Address - Street 1:40 N ALTADENA DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3386
Practice Address - Country:US
Practice Address - Phone:626-395-9307
Practice Address - Fax:626-395-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245-0811-1251B00000X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health