Provider Demographics
NPI:1770854390
Name:ABLE FAMILY SUPPORT
Entity type:Organization
Organization Name:ABLE FAMILY SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-8902
Mailing Address - Street 1:14418 CHASE ST
Mailing Address - Street 2:200
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3022
Mailing Address - Country:US
Mailing Address - Phone:310-500-8902
Mailing Address - Fax:
Practice Address - Street 1:904 E. KING BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:310-500-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17980801944OtherDRUG MEDI-CAL