Provider Demographics
NPI:1316115447
Name:ABRAHAM LINCOLN HIGH SCHOOL
Entity type:Organization
Organization Name:ABRAHAM LINCOLN HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:CUELLAR
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:323-728-0100
Mailing Address - Street 1:3501 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2856
Mailing Address - Country:US
Mailing Address - Phone:323-728-0100
Mailing Address - Fax:323-728-9218
Practice Address - Street 1:5723 E. WHITTIER BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-278-0100
Practice Address - Fax:323-728-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health