Organization
AMERICAN SUPPORT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADELINE EKWEBELEM MADAUBUCHI (CHIEF EXECUTIVE OFFICER)
(310) 644-1288
Entity
Organization
Contact information
Practice address
15222 ERIEL AVE, GARDENA, CA 90249-4019
(310) 644-1288
(310) 856-4705
Mailing address
15222 ARIEL AVE, GARDENA, CA 90249
(310) 644-1288
(310) 856-4705
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
190587AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190587AN
PROVIDER NUMBER
CA
Enumeration date
02/20/2008
Last updated
02/20/2008
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