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601 Grace Ave Inglewood CA 90301-1306 | |
| (310) 910-0230 | |
| (484) 227-8419 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 601 Grace Ave, Inglewood, California |
| Authorized Official Name and Position | Paul Radke (TREASURER) |
| Authorized Official Contact | 3106410870 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
601 Grace Ave Inglewood CA 90301-1306 Ph: (310) 910-0230 | 601 Grace Ave Inglewood CA 90301-1306 Ph: (310) 910-0230 |
| NPI Number | 1285127183 |
|---|---|
| Provider Enumeration Date | 06/14/2018 |
| Last Update Date | 03/19/2020 |
| Certification Date | 03/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285127183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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