Provider Demographics
NPI:1720327356
Name:GIFT OF HOPE AND HEALING, INC. SATELLITE
Entity Type:Organization
Organization Name:GIFT OF HOPE AND HEALING, INC. SATELLITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AWANYAI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:323-565-2043
Mailing Address - Street 1:8455 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1519
Mailing Address - Country:US
Mailing Address - Phone:323-565-2043
Mailing Address - Fax:323-565-2044
Practice Address - Street 1:1541 W 110TH ST
Practice Address - Street 2:DUKE ELINGTON HIGH SCHOOL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4912
Practice Address - Country:US
Practice Address - Phone:323-565-2043
Practice Address - Fax:323-565-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility