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Organization
PRIDE HEALTH SERVICES
Active
Organization
PRIDE HEALTH SERVICES
Active
Other names
Pride Health Services Vermont
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODFREY NWOGENE (EXECUTIVE DIRECTOR)
(310) 677-9019
Entity
Organization
Contact information
Practice address
8904 S VERMONT AVE, LOS ANGELES, CA 90044-4834
(323) 753-5950
(323) 753-6020
Mailing address
8904 S VERMONT AVE, LOS ANGELES, CA 90044-4834
(323) 753-5950
(323) 753-6020
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
190212AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
701231
DRUG MEDI-CAL
CA
Enumeration date
04/23/2007
Last updated
05/07/2009
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