Provider Demographics
NPI:1245969203
Name:17TH DISTRICT INC.
Entity type:Organization
Organization Name:17TH DISTRICT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-517-3178
Mailing Address - Street 1:13547 VENTURA BLVD # 232
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3825
Mailing Address - Country:US
Mailing Address - Phone:323-517-3178
Mailing Address - Fax:
Practice Address - Street 1:3575 CAHUENGA BLVD W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1366
Practice Address - Country:US
Practice Address - Phone:323-517-3178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle