Basic Information
| Provider Information | |||||||||
| NPI: | 1538399043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERNIE'S LIL WOMEN CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 942 E 11TH STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900591602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132801012 | ||||||||
| FaxNumber: | 3232498367 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 E ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132801012 | ||||||||
| FaxNumber: | 3232499026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOUDEAU | ||||||||
| AuthorizedOfficialFirstName: | BERNADINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2132801012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 7118 | 05 | CA | MEDICAID |