Basic Information
| Provider Information | |||||||||
| NPI: | 1649664491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERSONAL INVOLVEMENT CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 514839 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900512839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665080311 | ||||||||
| FaxNumber: | 3237780485 | ||||||||
| Practice Location | |||||||||
| Address1: | 24404 SOUTH VERMONT AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665080311 | ||||||||
| FaxNumber: | 3237780485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIGGS | ||||||||
| AuthorizedOfficialFirstName: | MAXINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8665080311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7542A | 05 | CA | MEDICAID |