Provider Demographics
NPI:1497570162
Name:T.D.D. SUPPORTIVE LIVING INC
Entity type:Organization
Organization Name:T.D.D. SUPPORTIVE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMPSS #MPSS-OUQDWB
Authorized Official - Phone:323-899-9398
Mailing Address - Street 1:4604 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1214
Mailing Address - Country:US
Mailing Address - Phone:323-899-9398
Mailing Address - Fax:323-978-6903
Practice Address - Street 1:235 W 99TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-4116
Practice Address - Country:US
Practice Address - Phone:323-899-9398
Practice Address - Fax:323-978-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management