Provider Demographics
NPI:1740918846
Name:THOMAS HOUSE TEMPORARY SHELTER
Entity type:Organization
Organization Name:THOMAS HOUSE TEMPORARY SHELTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKOYA
Authorized Official - Middle Name:DENISHA
Authorized Official - Last Name:GREEN LONG
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:951-238-0920
Mailing Address - Street 1:PO BOX 2737
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-2737
Mailing Address - Country:US
Mailing Address - Phone:714-554-0357
Mailing Address - Fax:
Practice Address - Street 1:12601 MORNINGSIDE AVE APT 6
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4517
Practice Address - Country:US
Practice Address - Phone:714-554-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management