Organization
BLACK FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BRIDGES (CEO)
(310) 210-0996
Entity
Organization
Contact information
Practice address
4571 W WASHINGTON BLVD, LOS ANGELES, CA 90016-1717
(323) 931-3211
Mailing address
450 E SILVERADO RANCH BLVD # 200, LAS VEGAS, NV 89183-6203
(323) 931-3211
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
ADP190249AN
CA
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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