| Lifted Foundation Llc | |
|
8363 Reseda Blvd Suite 203 E Northridge CA 91324-4623 | |
| (818) 727-7742 | |
| Not Available |
| Full Name | Lifted Foundation Llc |
|---|---|
| Speciality | Case Management |
| Location | 8363 Reseda Blvd, Northridge, California |
| Authorized Official Name and Position | Tanyatta Chateau (CLINICAL SOCIAL WORKER/ MANAGER) |
| Authorized Official Contact | 8186069836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifted Foundation Llc 8363 Reseda Blvd Suite 203 E Northridge CA 91324-4623 Ph: (818) 727-7742 | Lifted Foundation Llc 8363 Reseda Blvd Suite 203 E Northridge CA 91324-4623 Ph: (818) 727-7742 |
| NPI Number | 1710398250 |
|---|---|
| Provider Enumeration Date | 05/19/2014 |
| Last Update Date | 11/05/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710398250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCS 23309 (California) | Secondary |
| 251B00000X | Case Management | LCS 23309 (California) | Primary |
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