Provider Demographics
NPI:1619856788
Name:LOS ANGELES WIDE COMMUNITY SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:LOS ANGELES WIDE COMMUNITY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-483-9279
Mailing Address - Street 1:403 E 186TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2119
Mailing Address - Country:US
Mailing Address - Phone:310-483-9279
Mailing Address - Fax:
Practice Address - Street 1:8611 CRENSHAW BLVD STE 203
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2398
Practice Address - Country:US
Practice Address - Phone:310-910-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES WIDE COMMUNITY SUPPORT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-02
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage