Provider Demographics
NPI:1669616827
Name:ARMS OF GRACE
Entity type:Organization
Organization Name:ARMS OF GRACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COOR.
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DIPLOMA
Authorized Official - Phone:323-750-8040
Mailing Address - Street 1:2931 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5110
Mailing Address - Country:US
Mailing Address - Phone:323-750-8040
Mailing Address - Fax:323-750-8075
Practice Address - Street 1:2931 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5110
Practice Address - Country:US
Practice Address - Phone:323-750-8040
Practice Address - Fax:323-750-8075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12345678TMedicare PIN
CA1234Medicare PIN