Provider Demographics
NPI:1487898664
Name:INSTITUTE FOR MAXIMUM HUMAN POTENTIAL
Entity type:Organization
Organization Name:INSTITUTE FOR MAXIMUM HUMAN POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-567-9883
Mailing Address - Street 1:PO BOX 72059
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-0059
Mailing Address - Country:US
Mailing Address - Phone:323-567-9883
Mailing Address - Fax:323-567-9885
Practice Address - Street 1:9624 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2333
Practice Address - Country:US
Practice Address - Phone:323-567-9883
Practice Address - Fax:323-567-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency