Organization
NEWBLKWALSTREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERMAINE HAGAN (OWNER)
(562) 305-9143
Entity
Organization
Contact information
Practice address
1052 E BRENNER DR, CARSON, CA 90746-2407
(562) 305-9143
Mailing address
1052 E BRENNER DR, CARSON, CA 90746-2407
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/22/2025
Last updated
11/22/2025
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