Individual ProviderElijah FagginsCounselorBehavioral Health & Social Service ProvidersPractice Address5310 S Hoover St, Los Angeles, CA 90037-3734(310) 916-3532PECOS EnrollmentBased on the most recent information from CMS, provider Elijah Faggins does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1659571735Provider TypeIndividualFull NameFaggins, ElijahGenderMaleSole ProprietorNoEnumeration Date7/18/2007Last Updated7/18/2007Contact InformationPractice LocationPractice Address5310 S Hoover St, Los Angeles, CA 90037-3734Phone(310) 916-3532FaxUnlisted FaxMailing LocationMailing Address5310 S Hoover St, Los Angeles, CA 90037-3734PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID5698DescriptionOtherIssuerCASCalifornia