Provider Demographics
NPI:1730649674
Name:LADERA EDUCATION INSTITUTE
Entity Type:Organization
Organization Name:LADERA EDUCATION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:RADKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-641-0870
Mailing Address - Street 1:601 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1306
Mailing Address - Country:US
Mailing Address - Phone:310-641-0870
Mailing Address - Fax:310-641-8476
Practice Address - Street 1:601 GRACE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1306
Practice Address - Country:US
Practice Address - Phone:310-641-0870
Practice Address - Fax:310-641-8476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA LADERA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-25
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)