Provider Demographics
NPI:1154605939
Name:HANNA'S HOUSE
Entity type:Organization
Organization Name:HANNA'S HOUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SMOAK
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-278-6501
Mailing Address - Street 1:5900 S EASTERN AVE STE 186
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4018
Mailing Address - Country:US
Mailing Address - Phone:323-278-6501
Mailing Address - Fax:323-278-6515
Practice Address - Street 1:5900 S EASTERN AVE STE 142
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4024
Practice Address - Country:US
Practice Address - Phone:323-278-6501
Practice Address - Fax:323-278-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7429OtherDRUG MEDI-CAL