Provider Demographics
NPI:1043045040
Name:NIA FOUNDATION
Entity type:Organization
Organization Name:NIA FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-676-9664
Mailing Address - Street 1:5361 OVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2022
Mailing Address - Country:US
Mailing Address - Phone:562-480-7251
Mailing Address - Fax:
Practice Address - Street 1:5830 OVERHILL DR STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2710
Practice Address - Country:US
Practice Address - Phone:213-424-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty