Provider Demographics
NPI:1821302886
Name:HIS SHELTERING ARMS, INC.
Entity Type:Organization
Organization Name:HIS SHELTERING ARMS, INC.
Other - Org Name:HIS SHELTERING ARMS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RHOEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-755-6646
Mailing Address - Street 1:11101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1925
Mailing Address - Country:US
Mailing Address - Phone:323-755-6646
Mailing Address - Fax:323-776-1106
Practice Address - Street 1:11101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-1925
Practice Address - Country:US
Practice Address - Phone:323-755-6646
Practice Address - Fax:323-776-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190064CN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherDRUG MEDI-CAL