Provider Demographics
NPI:1386344158
Name:FT KNOX
Entity type:Organization
Organization Name:FT KNOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-394-1461
Mailing Address - Street 1:288 W TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4706
Mailing Address - Country:US
Mailing Address - Phone:626-394-1461
Mailing Address - Fax:323-998-7614
Practice Address - Street 1:16332 E EDNA PL
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2328
Practice Address - Country:US
Practice Address - Phone:626-394-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management