Organization
A.F.F.R.E.E.C.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVY NGENE LVN (LVN)
(310) 590-8740
Entity
Organization
Contact information
Practice address
879 W 190TH ST STE 430, GARDENA, CA 90248-4273
(310) 590-8740
Mailing address
879 W 190TH ST STE 430, GARDENA, CA 90248-4273
(310) 590-8740
(310) 532-0763
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2050X
Respite Care Camp
—
—
Other
Enumeration date
10/07/2019
Last updated
12/04/2024
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