Provider Demographics
NPI:1366429185
Name:BERNIE'S LIL WOMEN CENTER, INC.
Entity type:Organization
Organization Name:BERNIE'S LIL WOMEN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-280-1012
Mailing Address - Street 1:942 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1602
Mailing Address - Country:US
Mailing Address - Phone:213-280-1012
Mailing Address - Fax:323-563-7087
Practice Address - Street 1:8042 YOLANDA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1257
Practice Address - Country:US
Practice Address - Phone:213-280-1012
Practice Address - Fax:323-563-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190472AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7118Medicaid