Basic Information
| Provider Information | |||||||||
| NPI: | 1548789753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 1736 FAMILY CRISIS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2116 ARLINGTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237373900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2116 ARLINGTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237373900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROEBUCK | ||||||||
| AuthorizedOfficialFirstName: | DEZARAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMPLOYMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3237373900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.