Provider Demographics
NPI:1285127183
Name:LADERA EDUCATION INSTITUTE
Entity type:Organization
Organization Name:LADERA EDUCATION INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RADKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-641-0870
Mailing Address - Street 1:601 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1306
Mailing Address - Country:US
Mailing Address - Phone:310-910-0230
Mailing Address - Fax:310-641-8476
Practice Address - Street 1:601 GRACE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1306
Practice Address - Country:US
Practice Address - Phone:310-910-0230
Practice Address - Fax:484-227-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No253J00000XAgenciesFoster Care Agency