Provider Demographics
NPI:1558555730
Name:SPECIAL SERVICES FOR GROUPS
Entity type:Organization
Organization Name:SPECIAL SERVICES FOR GROUPS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SSG EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HATANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:213-553-1800
Mailing Address - Street 1:605 W OLYMPIC BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1475
Mailing Address - Country:US
Mailing Address - Phone:213-553-1800
Mailing Address - Fax:
Practice Address - Street 1:98 BOSWORTH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1002
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health