American Support Group

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

190587AN Issued in CA

Legal business name

AMERICAN SUPPORT GROUP

Practice address

15222 Eriel Ave
Gardena, CA 90249-4019

Phone

(310) 644-1288

Fax

(310) 856-4705

NPI assigned

Feb 20, 2008

Last updated

Feb 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Adeline Ekwebelem Madaubuchi

Title

Chief Executive Officer

Phone

(310) 644-1288

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adeline E Maduabuchi, CHIEF EXECUTIVE OFFI

  • Addiction (Substance Use Disorder) Counselor
  • Gardena, CA
  • NPI 1467621037
  NPD (past)
• Victor Maduabuchi, PROGRAM MANAGER

  • Addiction (Substance Use Disorder) Counselor
  • Gardena, CA
  • NPI 1407024185
  NPD (past)

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1457529760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15222 ARIEL AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "90249",
            "telephone_number": "310-644-1288",
            "fax_number": "310-856-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15222 ERIEL AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494019",
            "telephone_number": "310-644-1288",
            "fax_number": "310-856-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN SUPPORT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "MADAUBUCHI",
        "authorized_official_first_name": "ADELINE",
        "authorized_official_middle_name": "EKWEBELEM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-644-1288",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "190587AN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "190587AN",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Maria Amezcua
• Moises Amezcua
• Johan Anthony Amezola
• Amir Saz, DDS, a Dental Corporation

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Gardena, CA
• Providers in Gardena, CA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.