Provider Demographics
NPI:1255025862
Name:EYE4PEACE COMMUNITY SERVICES CORPORATION
Entity type:Organization
Organization Name:EYE4PEACE COMMUNITY SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-484-4177
Mailing Address - Street 1:11311 HAWTHORNE BLVD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-2775
Mailing Address - Country:US
Mailing Address - Phone:310-484-4177
Mailing Address - Fax:
Practice Address - Street 1:11311 HAWTHORNE BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-2775
Practice Address - Country:US
Practice Address - Phone:310-484-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health