Provider Demographics
NPI:1184769143
Name:GORETTI HEALTH SERVICES INC.
Entity type:Organization
Organization Name:GORETTI HEALTH SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARDS
Authorized Official - Middle Name:BEDE
Authorized Official - Last Name:NZENWA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD BUSSINESS ADMI
Authorized Official - Phone:310-973-0100
Mailing Address - Street 1:14623 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1581
Mailing Address - Country:US
Mailing Address - Phone:310-973-0100
Mailing Address - Fax:310-973-0099
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1581
Practice Address - Country:US
Practice Address - Phone:310-973-0100
Practice Address - Fax:310-973-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190559AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02873307Medicare ID - Type UnspecifiedDRUG-MEDICAL