Provider Demographics
NPI:1902109820
Name:PROTOTYPES CENTERS FOR INNOVATION IN HEALTH, MH, & SOCIAL SERVICES
Entity Type:Organization
Organization Name:PROTOTYPES CENTERS FOR INNOVATION IN HEALTH, MH, & SOCIAL SERVICES
Other - Org Name:PROTOTYPES CENTERS FOR INNOVATION IN HEALTH, MH, & SOCIAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MBA
Authorized Official - Phone:213-542-3838
Mailing Address - Street 1:1000 N ALAMEDA ST
Mailing Address - Street 2:SUITE 390
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1804
Mailing Address - Country:US
Mailing Address - Phone:213-542-3838
Mailing Address - Fax:213-225-0085
Practice Address - Street 1:11100 VALLEY BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2500
Practice Address - Country:US
Practice Address - Phone:626-444-0705
Practice Address - Fax:626-444-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health