Provider Demographics
NPI:1982945689
Name:LEMON HEIGHTS HOLDINGS INC.
Entity Type:Organization
Organization Name:LEMON HEIGHTS HOLDINGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NILS
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-860-2210
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-2089
Mailing Address - Country:US
Mailing Address - Phone:562-860-2210
Mailing Address - Fax:714-940-0941
Practice Address - Street 1:17215 STUDEBAKER ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2521
Practice Address - Country:US
Practice Address - Phone:562-860-2210
Practice Address - Fax:562-860-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10129103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY101290Medicaid
CACP10129Medicare PIN