Los Angeles Wings of Faith

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LOS ANGELES WINGS OF FAITH

Practice address

9626 Avalon Blvd
Los Angeles, CA 90003-4311

Phone

(323) 833-9719

Fax

(323) 779-6495

NPI assigned

Apr 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry C Jackson

Title

Ceo

Phone

(323) 833-2719

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386868685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9626 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900034311",
            "telephone_number": "323-833-9719",
            "fax_number": "323-779-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9626 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900034311",
            "telephone_number": "323-833-9719",
            "fax_number": "323-779-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES WINGS OF FAITH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-833-2719"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.