Provider Demographics
NPI:1932344777
Name:OUR HOUSE THEATRICAL LIVING & LEARNING CENTER
Entity Type:Organization
Organization Name:OUR HOUSE THEATRICAL LIVING & LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-C.E.O.- DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHALWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-763-4998
Mailing Address - Street 1:1132 E. DOMINGUEZ ST.
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:310-763-4998
Mailing Address - Fax:310-886-3064
Practice Address - Street 1:1132 E. DOMINGUEZ ST.
Practice Address - Street 2:SUITE B & C
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-763-4998
Practice Address - Fax:310-886-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS.PERMIT NO.62287A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA198600661OtherFACILITY #