Organization
SHIELDS FOR FAMILIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN S ICENHOWER PH.D. (EXECUTIVE DIRECTOR)
(323) 242-5000
Entity
Organization
Contact information
Practice address
2620 INDUSTRY WAY, SUITE A, LYNWOOD, CA 90262-4024
(323) 242-5000
(323) 242-5011
Mailing address
11601 S WESTERN AVE, LOS ANGELES, CA 90047-5006
(323) 242-5000
(323) 242-5011
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7365
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
03/12/2007
Last updated
11/04/2024
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