Basic Information
| Provider Information | |||||||||
| NPI: | 1144641341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LATINAS RECOVERY HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3316-3322 W. BEVERLY BLVD. | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237224529 | ||||||||
| FaxNumber: | 3237224450 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 N ST LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232617810 | ||||||||
| FaxNumber: | 3232611375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2013 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUPLESSIS | ||||||||
| AuthorizedOfficialFirstName: | GERMEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROJECT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3237224529 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 190065EN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 190065EN | 01 | CA | DEPARTMENT OF HEALTH CARE SERVICES/ SUBSTANCE ABUSE PREVENTION &CONTROL | OTHER |